Behavioral Counseling to Prevent Sexually Transmitted Infections: A Systematic Review for the U.S. Preventive Service Task Force

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Table 2: Effectiveness of Behavioral Counseling Interventions to Reduce STIs in Adults and Adolescents Based on Randomized, Controlled Trials (Key Question 1)

Study, Year (Reference)	Study Quality	Study Sample	Setting	Counseling Intervention	STI Outcome at Followup*
Adults
Petersen et al., 2007¹⁴	Fair	n = 737; age range, 16-44 y; 0% male	PC clinics	Pregnancy and STI risk reduction based on motivational interviewing IG1: moderate or high—unknown duration; 2 individual sessions CG: single-session general health promotion counseling	STI-positive (for chlamydia): Total: 1%; NS differences between groups, data not shown STI-positive (for any other STI by self-report or chart review): Total: 8%; NS differences between groups, data not shown
Jemmott et al., 2007¹³	Good	n = 564; mean age, 27 y; 0% male	PC clinics	Culturally tailored, skills-based intervention based on social cognitive behavioral theory IG1: high—200 min total; 1 group session IG2: low—20 min total; 1 individual session CG: matched general health promotion counseling	STI-positive (for gonorrhea, chlamydia, trichomonas), adjusted: IG1: 15% IG2: 14% CG: 27%; P = 0.03 (IG1 and IG2 vs. CG)
Shain et al., 2004¹⁵; Project SAFE 2	Fair	n = 775 (690 in analysis); mean age, 21 y; 0% male	STI clinic	Culturally tailored ARRM IG1 and IG2: high—9 h total; 3 group sessions ± optional support group sessions CG: usual care, 15-min counseling	STI-positive (for gonorrhea, chlamydia), adjusted: IG1: 15.7%, P = 0.006; OR, 0.51 (95% CI, 0.31-0.83) IG2: 15.4%, P = 0.004; OR, 0.50 (CI, 0.31-0.80) CG: 26.8%
Shain et al., 1999¹⁶; Project SAFE	Good	n = 617 (549 in analysis); mean age, 21 y; 0% male	STI clinic	Culturally tailored ARRM IG: high—9 to 12 h total; 3 group sessions CG: usual care, 15-min counseling	STI-positive (for gonorrhea, chlamydia), adjusted: IG: 16.8%; P = 0.004; OR, 0.52 (CI, 0.34-0.81) CG: 26.9%
Kamb et al., 1998¹⁷; Project RESPECT	Fair	n = 5758; median age, 25 y; 57% male	STI clinics	Enhanced CDC's client-centered HIV prevention counseling model IG1: high—200 min total; 4 individual sessions IG2: moderate—40 min total; 2 individual sessions CG: usual care, 10-min information only	STI-positive (for gonorrhea, chlamydia, syphilis, HIV), adjusted: IG1: 11.5%; RR, 0.78 (CI, 0.64-0.94) IG2: 12.0%; RR, 0.81 (CI, 0.67-0.98) CG1: 14.6%
Boyer et al., 1997¹⁸	Fair	n = 393; age range, 18-35 y; 67% male	STI clinic	ARRM IG: high—4 h total; 4 individual sessions CG: usual care, 15-min counseling	STI-positive at 6 mo (for any STI): IG: 6.8% (male); 21.8% (female); P = NS CG: 7.0% (male); 22% (female)
Carey et al., 2004¹⁹	Fair	n = 408; median age, 36 y; 46% male	Psychiatric clinic	HIV harm reduction model and motivational techniques IG: high—unknown total hours; 10 group sessions CG1 and CG2: matched substance abuse counseling or usual care	Self-report (at 6 mo) of new STI diagnosis at 6 mo, adjusted: IG: 2% CG1: 8%; P = 0.013 CG2: 5%; P = 0.046
Scholes et al., 2003²⁰	Fair	n = 1210; mean age, 21 y; 0% male	PC clinics	Individually tailored self-help printed materials based on multiple social science theories IG: low—2 mailings: 12-page booklet and booster newsletter CG: usual care, details NR	Self-report (at 6 mo) of STI diagnosis in past 3 mo, adjusted: IG: 3.5%; P = 0.93; OR, 0.97 (CI, 0.48-1.96) CG: 3.6%
Adolescents
Jemmott et al., 2005²²	Good	n = 682; mean age, 15 y; 0% male	PC clinic	Culturally tailored, skills-based intervention based on cognitive behavioral theories IG1 and IG2: high—250 min total; 1 group session ± skills training CG: matched general health promotion counseling	STI-positive (for gonorrhea, chlamydia, trichomonas), adjusted: IG1: 10.5%; P = 0.05 IG2: 14.4%; P = 0.44 CG: 18.2%
DiClemente et al., 2004²³	Good	n = 522; mean age, 16 y; 0% male	PC clinics	Culturally tailored social cognitive theory and theory of gender and power; with peer co-facilitators IG: high—4 h total; 4 group sessions CG: matched nutrition and exercise counseling	STI incidence per 100 person-months (crude) and OR (adjusted): Chlamydia: IG: 2.1; CG: 2.0 OR, 0.17 (CI, 0.03-0.92) Gonorrhea: IG: 0.9; CG: 0.7 OR, 0.14 (CI, 0.01-3.02) Trichomonas: IG: 0.9; CG: 1.2 OR, 0.37 (CI, 0.09-1.46)
Kamb et al., 1998¹⁷; Bolu et al., 2004²⁴; Project RESPECT	Fair	n = 764 (subgroup analysis of 5758); subgroup age < 20 y	STI clinics	Enhanced CDC's client-centered HIV prevention counseling model IG1: high—200 min total; 4 individual sessions IG2: moderate—40 min total; 2 individual sessions CG: usual care, 10-min information only	STI-positive (for gonorrhea, chlamydia, syphilis, HIV), adjusted: IG1: 17.2%; RR, 0.57 (CI, 0.37-0.90) IG2: 17.5%; RR, 0.58 (CI, 0.37-0.92) CG1: 26.6%
Boekeloo et al., 1999²¹	Fair	n = 219; age 12-15 y (mean NR); 50% male	PC clinics	Physician counseling based on 15-min audiotape risk assessment done in waiting period IG: low—unknown total duration; "brief" individual session CG: usual care, details NR	Self-report (at 9 mo) of STI (told by physician/nurse): IG: 0%; P = NS CG: 2.9% Self-report (at 9 mo) of treatment for STI: IG: 1.1%; P = NS CG: 5.8%

ARRM = AIDS risk reduction model; CDC = Centers for Disease Control and Prevention; CG = control group; IG = intervention group; NR = not reported; NS = not significant; OR = odds ratio; PC = primary care; RESPECT = Review, Enhance, Situations, Plan, Examine, Challenge, Tell; RR = relative risk; SAFE = Sexual Awareness for Everyone; STI = sexually transmitted infection.

* Or longest follow-up if otherwise specified.

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