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Sunday, 17 October 2004

This presentation is part of: Poster Session - Public Health; Methodological Advances

EFFECTS OF BEHAVIORAL INTERVENTIONS CONDUCTED IN U.S. STD CLINICS ON THE REDUCTION OF UNSAFE SEXUAL BEHAVIORS AND STD REINFECTION: META-ANALYSIS

Angela S. Kim, MPH1, Tanesha Griffin, MPH2, Paola C. Marrero-Gonzalez, MPH1, Sima M. Rama, MPH1, and Nicole Crepaz, PhD3. (1) Business Computer Application, Inc./Northrop Grumman Mission Systems, Prevention Research Branch/CDC, Atlanta, GA, (2) Northrop Grumman Mission Systems, Program Evaluation Research Branch, CDC, Centers for Disease Control and Prevention, Atlanta, GA, (3) Division of HIV/AIDS Prevention, NCHSTP, CDC, Prevention Research Branch, Atlanta, GA

Background: Patients attending STD clinics for testing and medical treatment are at elevated risk for HIV and STD infections. Interventions conducted in this setting provide a great opportunity to modify high-risk behaviors, thus preventing HIV and STD transmission. We performed a systematic review and meta-analysis of the HIV/STD behavioral prevention literature to identify interventions designed to reduce risky sexual behavior among U.S. STD clinic patients.

Methods: Systematic searches of 5 electronic databases were conducted to identify HIV/STD behavioral intervention evaluations published from 1988-2004 targeting STD clinic patients in the U.S. Studies were included if they had control/comparison groups and evaluated changes in biologic outcomes (STD reinfection assessed by medical chart review) and/or sex-risk behaviors (self-reported condom use or unprotected sex). Effect sizes (ESs) were estimated with odds ratios (ORs) and random-effects models were used to aggregate data.

Results: Thirteen intervention studies (11 RCTs, 2 quasi-experimental studies) met the inclusion criteria. The majority (ranging from 55% to 100%) of the study samples were ethnic minority groups, primarily African Americans and Hispanics. Overall, behavioral interventions had a significant impact on reduction of sexual risk behavior (OR= 0.55; 95% CI = 0.33, 0.91, 10 ESs). However, the intervention effects on preventing new STD reinfection fell short of significance (OR= 0.88; 95% CI = 0.70, 1.09; 14 ESs). Interventions provided skills training on condom use and negotiating safer sex with partners were effective in reducing sexual risk behaviors.

Conclusions: Behavioral interventions successfully modify high-risk behaviors of STD clinic patients, primarily African Americans and Hispanics - two populations which are greatly affected by HIV/STD epidemics. Although it was not significant, a 12% reduction of STD was observed. These different findings may be due to the sensitivity of outcome measures to detect changes or data collection and outcome classification issues, therefore further research is required. Nevertheless, interventions that promoted technical and interpersonal skills were effective in reducing sexual risk behaviors in STD clinics.


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