Authors' objectives:

Sexually transmitted infections (STIs) are an important and increasing cause of morbidity in the UK, and may lead to long-term problems such as reduced fertility, pain, psychological distress and, particularly in the case of Human Immunodeficiency Virus (HIV), disability and death. The burden of infections is not distributed evenly within the population, and these inequalities are compounded by the stigma that accompanies STIs. Despite this, genitourinary medicine (GUM) clinics offering investigation and treatment for STIs are currently under increasing pressure and waiting times for appointments are rising.

This review follows a request by a local West Midlands GUM clinician who sought evidence on whether offering a behavioural intervention to clinic patients would reduce their likelihood of re-infection and re-attendance.

Authors' results and conclusions: This review did not find consistent evidence that behavioural interventions can reduce STI rates in the target population, though studies were generally effective at increasing the proportion of subjects reporting consistent condom use. Four studies reported a greater reduction in laboratory confirmed infection rates among their intervention groups, two of which were statistically significant (p<0.05). These studies included the two largest, recruiting adults of both sexes, and were generally of higher quality than others included in the review. Three were based on the theory of reasoned action or related social cognitive theory. Results were not apparently related to the number of intervention sessions or format. There was no consistent evidence that interventions reduced the number of new sexual partners or their risk characteristics.

Authors' recommendations: Existing evidence does not support the immediate introduction of behavioural interventions into UK GUM clinics, though there was evidence to indicate that an appropriately tailored intervention could be effective in reducing STIs. In contrast, most interventions did increase the report of consistent condom use. The apparent contradiction between infection related and behavioural outcomes could be due to the inadequate power to detect changes to STI rates, or bias in the way these different outcomes were determined. Alternatively, condom use alone may relate poorly to overall STI risk, which is the sum of many complex aspects of behaviour. Additional research should aim to establish the effectiveness of interventions in a UK context while seeking to improve on the overall quality of studies. Research should also consider the feasibility and cost of introducing such interventions into routine practice.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/2004/genitourinary.pdf

Year Published: 2004

URL for published report: http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/WMHTAC/REP/reports-list.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: West Midlands Health Technology Assessment Collaboration

Contact Address: Elaena Donald-Lopez, West Midlands Health Technology Assessment Collaboration, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT Tel: +44 121 414 7450; Fax: +44 121 414 7878

Contact Name: louise.a.taylor@bham.ac.uk

Contact Email: louise.a.taylor@bham.ac.uk

Copyright: University of Birmingham