文章基本信息

标题：Meta-Analysis of Single-Session Behavioral Interventions to Prevent Sexually Transmitted Infections: Implications for Bundling Prevention Packages
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作者：Lisa A. Eaton ; Tania B. Huedo-Medina ; Seth C. Kalichman 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：102
期号：11
页码：e34-e44
DOI：10.2105/AJPH.2012.300968
语种：English
出版社：American Public Health Association
摘要：Evidence-based, single-session behavioral interventions are urgently needed for preventing the spread of HIV and other sexually transmitted infections (STIs). To estimate the efficacy of single-session, behavioral interventions for STI prevention, we collected data from 29 single-session interventions (20 studies; n = 52 465) with an STI outcome. Infection with an STI was 35% less likely (odds ratio = 0.65; 95% confidence interval = 0.55–0.77) among intervention group participants than among control group participants. Single-session interventions offer considerable benefits in terms of disease prevention and create minimal burden for both the patient and the provider. Brief and effective STI prevention interventions are a valuable tool and can be readily adapted to bolster the benefits of biomedical technologies focusing on the prevention of HIV and other STIs. INTERVENTIONS TARGETING prevention of HIV and other sexually transmitted infections (STIs) during the course of routine clinical services must be succinct to be effective. Interventions intended to reduce sexual risk behaviors and HIV and other STIs have been tested in a variety of clinical and community settings. Although behavioral interventions have demonstrated significant reductions in risk behaviors and have offered evidence of disease prevention, many consist of multiple steps and sessions, 1–5 thus placing a considerable burden on patients and requiring substantial resources. 4 Of particular concern is the feasibility of implementing multiple-session behavioral interventions in conjunction with currently available health care services. These services continue to face budget reductions that lead to staff shortages and limited means for retaining patients throughout the course of an extended intervention. 6 Limited resources can render multiple-session interventions unusable or force service providers to substantially modify these interventions. In addition to the need for brief behavioral interventions in the public health sector, there is a growing demand for feasible behavioral interventions that can be used in combination with biomedical prevention technologies. It is well recognized that no single prevention strategy, including behavioral interventions, male circumcision, preexposure and postexposure prophylaxis, vaccines, and vaginal or anal microbicides, will be completely effective in protecting individuals against infection with HIV and other STIs. 7–14 Furthermore, the effectiveness of biomedical prevention technologies can be undermined by changes in risk behaviors, such as risk compensation. 15 Single-session behavioral interventions can potentially add value to the protective effects of biomedical interventions. There is growing recognition of the need for bundling multiple prevention strategies to gain cumulative effects. 16,17 Behavioral risk reduction interventions can play a critical role in comprehensive programs designed to prevent the spread of HIV and other STIs, particularly when they are designed to fit within current health care services. 18 We conducted a meta-analysis to examine whether single-session risk reduction interventions targeting HIV and other STIs have positive effects on disease outcomes. We focused on STI outcomes because they are clinically meaningful indicators of intervention efficacy. Moreover, we chose single-session interventions because they are most likely to be successfully incorporated into existing services and meta-analyses have not, to date, focused on their effects. There are now sufficient numbers of STI trials with outcome data available to determine whether single-session interventions can lead to disease reductions relative to a standard of care. We also investigated moderators of STI outcomes to identify characteristics of single-session interventions that result in a reduced prevalence of disease. Finally, in a subset of studies that provided behavioral data related to sexual risk taking, we conducted an additional meta-analysis to determine whether single-session interventions improve condom use.