A Triadic Intervention for Adolescent Sexual Health: A Randomized Clinical Trial

Bacterial and viral sexually transmitted infections (STIs) are common in the US. Approximately 20 million new cases of bacterial or viral STIs occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. 1,2 Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. 2 Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. Untreated STIs that present during pregnancy or birth may cause harms to the mother and infant, including perinatal infection, serious physical and developmental disabilities, and death. 3,4 USPSTF Assessment of Magnitude of Net Benefit The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, resulting in a moderate net benefit. See the Figure and Table 1 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual. 5 IMPORTANCE Approximately 20 million new cases of bacterial or viral sexually transmitted infections (STIs) occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions for preventing STI acquisition. POPULATION This recommendation statement applies to all sexually active adolescents and to adults at increased risk for STIs. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, including for example, those who have a current STI, do not use condoms, or have multiple partners, resulting in a moderate net benefit. RECOMMENDATION The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation)

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“…36 A recent follow-up study using an updated version of the intervention in a broader group found similar results. 38…”

Section: Benefits Of Behavioral Counseling Interventionsmentioning

confidence: 99%

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections

Krist

Davidson

Mangione

et al. 2020

JAMA

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“…In this issue of Pediatrics, Guilamo-Ramos et al 3 provide rigorous evidence for a highly promising intervention, a triadic version of Families Talking Together (FTT). The triadic FTT intervention is innovative in that it involves African American and Latinx youth in early adolescence, their female caregivers, and their health care providers (HCPs).…”

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confidence: 99%

“…Regarding efficacy, Guilamo-Ramos et al 3 rigorously tested FTT among 900 mother-adolescent-HCP triads in a randomized clinical trial. One year after the intervention was complete, just 5% of adolescents receiving FTT had engaged in vaginal intercourse compared with 18% in the control condition.…”

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confidence: 99%

“…12 Given these personal and societal costs, how can we afford not to offer adolescents comprehensive sexual health interventions that could reduce sexual risk, such as the FTT intervention? As noted by Guilamo-Ramos et al, 3 triadic interventions offer a relatively low-cost tool to strengthen partnerships between parents, adolescents, and providers and increase the potency of health messaging. The FTT program, in particular, lowers costs by incorporating "provider extenders" (eg medical assistants and social workers) as intervention delivery partners.…”

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confidence: 99%

“…Here, we briefly highlight 3 avenues to improve the scalability of FTT and other promising sexual health interventions to have the greatest impact. First, as Guilamo-Ramos et al 3 have done, members of the target population (particularly adolescents) must be included throughout the research process, from intervention design to dissemination. When community members are involved from the moment of program conception, programs are more likely to be acceptable, feasible, and eventually adopted.…”

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confidence: 99%

See 2 more Smart Citations

Adolescent Sexual Health Interventions: Innovation, Efficacy, Cost, and the Urgent Need to Scale

Widman¹,

Evans²

2020

Pediatrics

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Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections

Henderson

Senger

Henninger

et al. 2020

JAMA

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Increasing rates of preventable sexually transmitted infections (STIs) in the US pose substantial burdens to health and well-being. OBJECTIVE To update evidence for the US Preventive Services Task Force (USPSTF) on effectiveness of behavioral counseling interventions for preventing STIs. DATA SOURCES Studies from the previous USPSTF review (2014); literature published January 2013 through May 31, 2019, in MEDLINE, PubMed (for publisher-supplied records only), PsycINFO, and Cochrane Central Register of Controlled Trials. Ongoing surveillance through May 22, 2020. STUDY SELECTION Good-and fair-quality randomized and nonrandomized controlled intervention studies of behavioral counseling interventions for adolescents and adults conducted in primary care settings were included. Studies with active comparators only or limited to individuals requiring specialist care for STI risk-related comorbidities were excluded. DATA EXTRACTION AND SYNTHESIS Dual risk of bias assessment, with inconsistent ratings adjudicated by a third team member. Study data were abstracted into prespecified forms. Pooled odds ratios (ORs) were estimated using the DerSimonian and Laird method or the restricted maximum likelihood method with Knapp-Hartung adjustment. MAIN OUTCOMES AND MEASURES Differences in STI diagnoses, self-reported condom use, and self-reported unprotected sex at 3 months or more after baseline. RESULTS The review included 37 randomized trials and 2 nonrandomized controlled intervention studies (N = 65 888; 13 good-quality, 26 fair-quality) recruited from primary care settings in the US. Study populations were composed predominantly of heterosexual adolescents and young adults (12 to 25 years), females, and racial and ethnic minorities at increased risk for STIs. Nineteen trials (n = 52 072) reported STI diagnoses as outcomes (3 to 17 months' follow-up); intervention was associated with reduced STI incidence (OR, 0.66 [95% CI, 0.54-0.81; I 2 = 74%]). Absolute differences in STI acquisition between groups varied widely depending on baseline population STI risk and intervention effectiveness, ranging from 19% fewer to 4% more people acquiring STI. Thirty-four trials (n = 21 417) reported behavioral change outcomes. Interventions were associated with self-reported behavioral change (eg, increased condom use) that reduce STI risk (OR, 1.31 [95% CI, 1.10-1.56; I 2 = 40%, n = 5253). There was limited evidence on persistence of intervention effects beyond 1 year. No harms were identified in 7 studies (n = 3458) reporting adverse outcomes. CONCLUSIONS AND RELEVANCE Behavioral counseling interventions for individuals seeking primary health care were associated with reduced incidence of STIs. Group or individual counseling sessions lasting more than 2 hours were associated with larger reductions in STI incidence, and interventions of shorter duration also were associated with STI prevention, although evidence was limited on whether the STI reductions associated with these interventions persisted beyond 1 year.

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A Triadic Intervention for Adolescent Sexual Health: A Randomized Clinical Trial

Cited by 28 publications

References 29 publications

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections

Adolescent Sexual Health Interventions: Innovation, Efficacy, Cost, and the Urgent Need to Scale

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections

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