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Behavioral Counseling to Prevent Sexually Transmitted Infections
Evidence Syntheses, No. 64
Investigators: Jennifer Lin, MD, Evelyn Whitlock, MD, MPH, Elizabeth O'Connor, PhD, and Vance Bauer, MA.
Author Information and AffiliationsStructured Abstract
Background:
Despite advances in prevention and treatment, sexually transmitted infections (STIs) remain a significant cause of morbidity and mortality in the United States. There are an estimated 19 million new infections each year in the US costing about $13 billion.
Purpose:
This systematic review supports the USPSTF in updating its prior recommendation on behavioral counseling to prevent STI.
Data Sources:
For four key questions, we searched Medline (ML), Cochrane Central Registry of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), PsycINFO (PI), and the CDC's Prevention Synthesis Research (PRS) Project's database from 1988 through December 2006. For the fifth key question, we searched ML and CCRCT from 1988 to August 2006. Literature searches were supplemented with outside source material from experts in the field and from examining the bibliographies of existing systematic reviews on these topics.
Study Selection:
This review included 19 articles representing 13 unique trials of counseling interventions and three trials for evaluating the effectiveness of female condoms. Included trials evaluated a primary care feasible behavioral counseling intervention addressing sexual behavior change to prevent the transmission of STIs.
Data Extraction:
Two investigators independently screened all abstracts and rated all articles meeting inclusion criteria. One primary reviewer abstracted relevant information into standardized evidence tables. A second reviewer checked the abstraction process.
Data Synthesis and Results:
Due to the heterogeneity of intervention methods, populations, and settings, we conducted a qualitative synthesis of our findings. The majority of evidence suggests a modest reduction in STIs at 6 or 12 months among “at-risk” adults in STI clinics receiving multiple intervention sessions, and at 12 months among sexually active adolescents. We also found evidence for increased compliance with treatment recommendations for adult women in STI clinics, general contraception use in male adolescents, and decreased nonsexual risky behavior and pregnancy in sexually active female adolescents. Overall, we found no evidence of significant behavioral or biological harms for risk-reduction counseling.
Limitations:
We did not find sufficient trials evaluating primary care feasible behavioral counseling interventions to prevent STIs in a general-risk population or certain “at-risk” groups.
Conclusions:
There is fair to good evidence suggesting that moderate- to high-intensity behavioral counseling conducted in STI clinics effectively reduces STI incidence in “at-risk” populations. Among sexually active adolescents, there is fair to good evidence that high-intensity behavioral counseling effectively reduces STI incidence in a primary care setting. There is a need for additional evidence for both lower-intensity behavioral counseling interventions and studies in lower-risk populations.
Contents
- 1. Introduction
- 2. Methods
- 3. Results
- Key Question 1. Is there direct evidence that behavioral counseling interventions to reduce risky sexual behaviors and increase protective sexual behaviors reduce STI incidence and/or related morbidity and mortality?
- Key Question 2. Do behavioral counseling interventions to prevent STIs in primary care reduce risky sexual behaviors or increase protective sexual behaviors?
- Key Question 3. Are there other positive outcomes besides sexual behavioral changes and reduced incidence of STI resulting from behavioral counseling interventions to prevent STIs in primary care?
- Key Question 4. What are the adverse effects associated with behavioral counseling interventions to prevent STIs in primary care to reduce risky sexual behaviors and increase protective sexual behaviors?
- Key Question 5. Do sexual behavioral changes, including reducing risky sexual behaviors and increasing protective sexual behaviors, lead to a reduced incidence of STIs and/or related morbidity and mortality?
- 4. Discussion
- Appendix A: Methods
- Appendix B: Evidence Tables
- Appendix C: Excluded studies table
- Appendix D: Studies in progress
- References
This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC)1 under contract to the Agency for Healthcare Research and Quality (AHRQ),2 Rockville, Maryland, under Contract No. 290-02-0024, Task Order Number 2.
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
- 1
Center for health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227.
- 2
U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, Maryland 20850. www
.ahrq.gov
- Behavioral counseling to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force.[Ann Intern Med. 2008]Behavioral counseling to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force.Lin JS, Whitlock E, O'Connor E, Bauer V. Ann Intern Med. 2008 Oct 7; 149(7):497-508, W96-9.
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