Article Text
PDF
Abstract
Background Increasing rates of sexually transmitted infections (STIs) and antimicrobial resistance among young people underscore the urgent need for preventative interventions. Interventions should be evidence-based and tailored to the unique risks and needs associated with varying age, sex and sexual orientation. We used data from the Safetxt trial to explore whether young people’s age, sex and sexual orientation influence (1) their risk of STI reinfection and condom use and (2) the effect of the Safetxt intervention on STI reinfection and condom use.
Methods We conducted exploratory secondary analyses of data from the Safetxt trial that evaluated a theory-based digital sexual health intervention tailored according to sex and sexual orientation. We recruited 6248 young people with STIs from 92 UK sexual health clinics and assessed outcomes after 1 year, including the cumulative incidence of STI reinfection and condom use at last sex. We used adjusted logistic regression and margins plots to visualise effect modification.
Results There were differences in STI reinfection and condom use by age, sex and sexuality. Age was associated with STI reinfection (OR 0.90, 95% CI 0.87 to 0.94) with evidence for interaction between age and sexuality (p<0.001). Our findings suggest that the risk of STI reinfection decreases with age among young heterosexuals but increases among men-who-have-sex-with-men (MSM). Overall, MSM had the highest likelihood of reinfection (OR 3.53, 95% CI 2.66 to 4.68) despite being more likely to use condoms (OR 1.50, 95% CI 1.18 to 1.91).
Among MSM, age modified the intervention effect on condom use at 1 year with highest benefits among participants aged 16–18, moderate to minor benefits among those aged 18–21 and no effect among participants aged 22–24 years.
Conclusions Future digital health interventions tailored for diverse sexuality groups need to target young people early enough to have an impact on sexual behaviour. Specific novel interventions are needed for older MSM.
Trial registration number ISRCTN64390461.
- condoms
- sexual health
- Telemedicine
- Homosexuality, Male
- Heterosexuality
Data availability statement
Data are available upon reasonable request. Individual deidentified patient data, including a data dictionary, will be made available via our data sharing portal FreeBIRD website indefinitely. The trial protocol, statistical analysis plan and trial publications will be available online. The Stata code for the secondary analyses will be made available on reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request. Individual deidentified patient data, including a data dictionary, will be made available via our data sharing portal FreeBIRD website indefinitely. The trial protocol, statistical analysis plan and trial publications will be available online. The Stata code for the secondary analyses will be made available on reasonable request.
Footnotes
Handling editor Kevin Martin
Contributors CF was the chief investigator of the Safetxt trial. CF, OM and FCIH contributed to writing the grant application and design of the Safetxt intervention. CF and OM contributed to the design of the trial. CF, OM and MJP contributed to the management of data collection. SB conceived the idea for this secondary analysis with input from MJP, CF and FCIH. JRC was one of the trial statisticians, on whose SAP and code some of the analyses in this paper were based. SB conducted the analyses for this study with input from MJP and EB. All authors contributed to the interpretation of results. SB wrote the first draft of the manuscript with input from MJP, CF, FCIH, EB and OM. All authors commented on revised versions and approved the final manuscript. CF is responsible for the overall content as guarantor and controlled the decision to publish.
Funding This study has been sponsored by the London School of Hygiene and Tropical Medicine and funded under the NIHR PHR Programme (Project ref 14/182/07). (Funders have not directly been involved in protocol development, review conduct, data analysis, interpretation and dissemination of the final report.)
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.