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Behavioral Sexual Risk Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force
Evidence Syntheses, No. 114
Investigators: Elizabeth O'Connor, PhD, Jennifer S Lin, MD, MCR, Brittany U Burda, MPH, Jillian T Henderson, PhD, Emily S Walsh, MPH, and Evelyn P Whitlock, MD, MPH.
Author Information and AffiliationsStructured Abstract
Background:
Sexually transmitted infections (STIs) are common and a source of substantial morbidity in the United States. Behavioral sexual risk reduction counseling in primary care may help prevent STIs.
Purpose:
To systematically review evidence on the benefits and harms of primary care–relevant behavioral counseling interventions designed to reduce STIs through reductions in risky sexual behaviors and increased protective sexual behaviors, to aid the U.S. Preventive Services Task Force (USPSTF) in updating its recommendation on this topic.
Methods:
Building on a previous review for the USPSTF, we searched a number of databases, including MEDLINE, PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials, to identify relevant literature published since the previous review (January 1, 2007 through November 4, 2012). We also examined references of other existing systematic reviews; searched Web sites of government agencies, professional organizations, and other organizations for grey literature; and monitored health news Web sites and journal tables of contents to identify potentially eligible trials. Two investigators independently reviewed identified abstracts and full-text articles against a set of a priori inclusion and quality criteria. One investigator abstracted data into an evidence table and a second investigator checked these data. We conducted random-effects meta-analyses to estimate the effect of sexual risk reduction counseling on STI incidence and, for adults only, condom use.
Results:
We included 31 trials reported in 57 publications; 16 (n=56,110) were newly published trials that were not included in the previous review, and 15 trials (n=14,214) were included in the previous review. High-intensity (>2 hours) interventions reduced STI incidence in adolescents and adults. Low- and moderate-intensity interventions were generally not effective in adults; however, we identified some promising low- and moderate-intensity approaches. Moderate-intensity interventions may be effective in adolescents, but data were sparse. Pooled effects showed the odds of acquiring an STI were reduced by 62 percent in adolescents (k=5) and 30 percent in adults (k=9) with high-intensity interventions. Reported behavioral outcomes were heterogeneous, and results were most likely to show a benefit with high-intensity interventions at 6 months or less. Most trials targeted populations at increased risk for STIs, as defined by sociodemographic characteristics, history of risky sexual behaviors, or history of an STI. We found no evidence that sexual risk reduction counseling could be harmful.
Conclusions:
High-intensity behavioral sexual risk reduction counseling can reduce the incidence of STIs in primary care and related clinical settings, especially in sexually active adolescents and in adults at increased risk for STIs. Less intensive interventions may also be effective in adolescents, but these data are still sparse. Findings are consistent with and expand upon the previous review on this topic.
Contents
- 1. INTRODUCTION
- Condition Definition
- Prevalence and Burden
- Etiology and Natural History
- Risk Factors
- Sexual Health History and Risk Assessment
- Counseling Interventions to Prevent STIs
- Current Clinical Practice in the United States
- Current Initiatives in the United States
- Related U.S. Preventive Services Task Force Recommendations
- Previous USPSTF Recommendation
- 2. METHODS
- 3. RESULTS
- Literature Search
- Description of Included Studies
- KQ 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?
- KQ 2 Do Behavioral Counseling Interventions to Prevent STIs Reduce Risky Sexual Behavior or Increase Protective Sexual Behavior?
- KQs 1a, 2a Are There Population or Intervention Characteristics That Influence the Effectiveness of Interventions?
- KQ 3 Are There Other Positive Outcomes Beside STI Incidence and Changes in Risky or Protective Sexual Behavior From Behavioral Counseling Interventions to Prevent STIs?
- KQ 4 What Adverse Effects Are Associated With Behavioral Counseling Interventions to Prevent STIs in Primary Care?
- 4. DISCUSSION
- REFERENCES
- Appendix A Detailed Methods
- Appendix B Excluded Studies
- Appendix C Summary Tables
- Appendix D Ongoing or Recently Completed Studies
Acknowledgments: The authors gratefully acknowledge the following individuals for their contributions to this project: Karen Lee, MD, MPH, at AHRQ; current and former members of the U.S. Preventive Services Task Force who contributed to topic deliberations; Ralph J. DiClemente, PhD, for providing expert review; Peter Miele, MD, and the Centers for Disease Control and Prevention for providing federal partner review of the report; and Smyth Lai, MLS, and Kevin Lutz, MFA, at the Kaiser Permanente Center for Health Research.
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHSA-290-2012-00151-I, Task Order No. 2. Prepared by: Kaiser Permanente Research Affiliates Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, OR
Suggested citation:
O'Connor E, Lin JS, Burda BU, Henderson JT, Walsh ES, Whitlock EP. Behavioral Sexual Risk Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 114. AHRQ Publication No. 13-05180-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.
This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2012-00151-I, Task Order No. 2). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, 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 health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment.
This report may be used, in whole or in part, as the basis for 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.
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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- Behavioral Sexual Risk Reduction Counseling in Primary Care to Prevent Sexually ...Behavioral Sexual Risk Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force
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