Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review

Long, Linda; Abraham, Charles; Paquette, Rachelle; Shahmanesh, Maryam; Llewellyn, Carrie; Townsend, Anne; Gilson, Richard

doi:10.1016/j.ypmed.2016.06.038

Cited by 22 publications

(32 citation statements)

References 81 publications

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“…Although the work demonstrated that developing such a tool was possible to a minimal threshold of clinical utility, further refinement and external validation is needed to improve the performance of the tool and assess the real-world applicability of this approach. 52 understanding what is currently offered as the standard of care across diverse services is important.…”

Section: Resultsmentioning

confidence: 99%

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Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study

King

Llewellyn

Shahmanesh

et al. 2019

Health Technol Assess

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Background Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. Objectives The study (Santé) had two main objectives – (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care. Design The project was a multistage, mixed-methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review, an analysis of national surveillance data, the development of a triage algorithm, and interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen. Setting SH clinics in England. Participants Young people (aged 16–25 years), and men who have sex with men. Intervention A three-part intervention package – (1) a triage tool to score patients as being at high or low risk of STI using routine data, (2) a study-designed web page with tailored SH information for all patients, regardless of risk and (3) a brief one-to-one session based on motivational interviewing for high-risk patients. Main outcome measures The three outcomes were (1) the acceptability of the intervention to patients and SH providers, (2) the feasibility of delivering the interventions within existing resources and (3) the feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial). Results We identified 33 relevant trials from the systematic review, including videos, peer support, digital and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated that these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% vs. 46%). Limitations Fewer clinics were included in the pilot than planned, limiting the ability to make strong conclusions on the feasibility of the RCT. Conclusion We were unable to conclude whether or not a definitive RCT would be feasible because of challenges in implementation of a pilot, but have laid the groundwork for future research in the area. Trial registration Current Controlled Trials ISRCTN16738765. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 12. See the NIHR Journals Library website for further project information.

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Section: Resultsmentioning

confidence: 99%

“…GUM, contraception and SH, and Brook services), focusing on the highest risk groups of MSM and young people. Some of this chapter is based on Long et al 52…”

Section: Chapter 2 Work Package 1: Systematic Literature Reviewmentioning

confidence: 99%

Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study

King

Llewellyn

Shahmanesh

et al. 2019

Health Technol Assess

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“…This is particularly the case in young people (defined as <25 years) and men who have sex with men (MSM) 1. Behavioural interventions can modify behaviours such as increasing condom use and STI testing, with some showing modest impacts on STI diagnosis rates 2–4. The UK National Survey of Sexual Attitudes and Lifestyles (NATSAL) found that a large proportion of individuals reporting sexual behaviours associated with increased risk of STI acquisition had attended sexual health clinics (SHC) 5.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, SHCs provide an opportunity to offer effective targeted behavioural interventions, such as one-to-one counselling,6 7 directing patients to digital interventions or by displaying informational videos in waiting areas 8 9. However, a systematic review from 2014 of brief behavioural interventions involving young people or MSM found only three effective trialled interventions from the UK, none of which targeted MSM, highlighting the need for intervention adaptation prior to implementation 2…”

Section: Introductionmentioning

confidence: 99%

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

Roy

King²,

Gilson

et al. 2019

Sex Transm Infect

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ObjectiveBehavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people (<25 years) and men who have sex with men (MSM) internationally, but evidence from England is limited. We aimed to explore service provider and user experiences and perspectives on behavioural interventions to reduce sexual behaviour risks, and the use of automated methods to triage individuals to these services.MethodsWe conducted a sequential mixed methods study with sexual health service providers and users in 2015/2016. Qualitative interviews with providers and service users (heterosexual young people and MSM) in London and Brighton allowed us to explore a range of experiences and expectations. A subsequent national web-survey of service providers measured the feasibility of delivery within existing resources and preferences for intervention attributes.ResultsWe conducted 35 service user (15 heterosexual young people; 20 MSM) and 26 provider interviews and had 100 web-survey responses. We found considerable heterogeneity in prevention services offered. Service users and providers were broadly supportive of tailoring interventions offered, but service users raised concerns about automated, data-driven triage, particularly around equity and fairness of service delivery. Digital technologies, including social media or apps, were appealing to providers, being less resource intensive. However, one-to-one talking interventions remained popular with both service users and providers, being familiar, trustworthy and personal. Key tensions between desirability of interventions and availability of resources to deliver them were acknowledged/recognised by providers and users.ConclusionOverall, behavioural interventions to reduce sexual behaviour risks were viewed favourably by service providers and users, with key considerations including: privacy, personalisation and convenience. However, introducing desirable targeted interventions within heterogeneous sexual health settings will require resources to adapt interventions and research to fully understand the barriers and facilitators to use within routine services.

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“…Several reviews have synthesised evidence on the effectiveness of behavioural and other interventions to promote the use of condoms, but these have been limited in the conclusions that can be drawn. [8][9][10][11] In particular, it has been difficult to ascertain what the effective components of the interventions are. A systematic overview of systematic reviews of behavioural interventions to increase condom use included 13 reviews covering a total of 248 individual primary studies in a variety of populations (e.g.…”

Section: Introductionmentioning

confidence: 99%

Evidence for behavioural interventions addressing condom use fit and feel issues to improve condom use: a systematic review

et al. 2019

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Continuing high rates of sexually transmissible infections (STIs) in many countries highlight the need to identify effective behavioural interventions. Consistent and correct use of male condoms is a key strategy for the prevention of STIs. However, some men report problems with condom fit (e.g. the size and shape of the condom) and feel (e.g. tightness, irritation, sensitivity), which inhibits their use. We conducted a systematic review to identify existing interventions addressing condom use fit and feel problems. We searched electronic databases for peer-reviewed articles and searched reference lists of retrieved studies. Five studies met the inclusion criteria. These were generally small-scale pilot studies evaluating behavioural interventions to promote safer sex with men aged under 30 years, addressing, among other things, barriers to condom use relating to fit and feel. There were significant increases in the reported use of condoms, including condom use with no errors and problems. Improvements in some condom use mediators were reported, such as condom use self-efficacy, knowledge, intentions and condom use experience. There were mixed findings in terms of the ability of interventions to reduce STI acquisition. Behavioural interventions addressing condom fit and feel are promising in terms of effectiveness but require further evaluation.

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Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review

Cited by 22 publications

References 81 publications

Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study

Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

Evidence for behavioural interventions addressing condom use fit and feel issues to improve condom use: a systematic review

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