The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR)

Crawford, Mike; Sanatinia, Rahil; Barrett, Barbara; Byford, Sarah; Dean, Madeleine; Green, John; Jones, Rachael; Leurent, Baptiste; Lingford‐Hughes, Anne; Sweeting, Michael; Touquet, Robin; Tyrer, Peter; Ward, Helen

doi:10.3310/hta18300

Cited by 13 publications

(13 citation statements)

References 36 publications

(55 reference statements)

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“…Consequently, we included interventions involving no more than three hours of contact time that aimed to reduce STI rates and/or increase STI test uptake and/or change STI-risk behavior patterns and had been evaluated using a randomized controlled trial (RCT). We noted the mode of delivery used and the change techniques incorporated in each intervention (9,10).…”

Section: Review Objective and Research Questionmentioning

confidence: 99%

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

Long

Abraham

Paquette

et al. 2016

Preventive Medicine

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Section: Review Objective and Research Questionmentioning

confidence: 99%

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

Long

Abraham

Paquette

et al. 2016

Preventive Medicine

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“…They might too call into question the recommendation of the investigators on the SHEAR project (Crawford et al, 2014) that ABI should not be routinely implemented in sexual health clinics on the basis of their findings (see above). These are difficult matters of judgment and this editorial does not take a definite stance on them; rather, the issues on both sides have been raised for the reader's consideration and in the interests of informed debate.…”

Section: Resultsmentioning

confidence: 99%

Spreading alcohol brief interventions from health care to non-health care settings: Is it justified?

Heather

2016

Drugs: Education, Prevention and Policy

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“…Several of the RCTs specifically targeted women, with 10 of the studies not including men, and only a single trial limited to sexually active young men. 74 Four RCTs recruited from STI clinics, 56,62,64,69 with two of these trials reporting reductions in STIs, 56,64 and two were based within schools. 57,71 Four out of five video interventions designed for young people (with or without counselling) were found to be beneficial for reducing STIs, 63 reducing RSB 63,73,76 or increasing STI test uptake.…”

Section: Young Peoplementioning

confidence: 99%

“…We found very few studies conducted in the UK, and only one within a UK SH setting. 62 Length of follow-up may have resulted in the apparent lack of impact seen on some sexual behavioural outcomes. It was notable that some interventions showed short-term improvement in outcomes, which was not seen later in the follow-up period.…”

Section: Strengths and Limitationsmentioning

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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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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The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR)

Cited by 13 publications

References 36 publications

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

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

Spreading alcohol brief interventions from health care to non-health care settings: Is it justified?

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

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