Location of Repository

The effectiveness and cost-effectiveness of behavioural interventions for the prevention of sexually transmitted infections in young people aged 13-19: a systematic review and economic evaluation

By Jonathan Shepherd, J. Kavanagh, Joanna Picot, Keith Cooper, A. Harden, E. Barnett-Page, J. Jones, A. Clegg, D. Hartwell, G.K. Frampton and A. Price


Objectives<br/><br/>To assess the effectiveness and cost-effectiveness of schools-based skills-building behavioural interventions to encourage young people to adopt and maintain safer sexual behaviour and to prevent them from acquiring sexually transmitted infections (STIs).<br/><br/>Data sources<br/><br/>Electronic bibliographic databases (e.g. MEDLINE, MEDLINE In-Process &amp; Other Non-Indexed Citations, EMBASE, CINAHL, PsycINFO, CCRCT, NHS EED and DARE) were searched for the period 1985 to March 2008. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify additional published and unpublished references.<br/><br/>Review methods<br/><br/>A systematic review of effectiveness and economic evaluation of cost-effectiveness were carried out. A descriptive map of studies that met inclusion criteria was produced, and keywords were developed and systematically applied to these studies to identify a policy-relevant subset of studies for the systematic review. Outcome data for variables including sexual behaviour were extracted. An economic model was developed to compare the costs and consequences of the behavioural interventions. A Bernoulli statistical model was constructed to describe the probability of STI infection.<br/><br/>Results<br/><br/>There were few significant differences between the interventions and comparators in terms of changes in sexual behaviour outcomes, although there were some significant differences for knowledge and some measures of self-efficacy. The studies included in this review conducted relatively short follow-up assessments at a time when many young people were becoming sexually active. It is therefore possible that favourable behaviour change may have occurred, and become more cost-effective, with time, as sexual activity becomes more routine in young people’s lives. The quality of the intervention provider influenced whether or not young people found the interventions to be acceptable and engaging; enthusiasm and considerable expertise were important for effective class management and delivery of skills-building activities, and a supportive school culture was also helpful. Recognition of young people’s individual needs in relation to sexual health was another important factor. No conclusions could be drawn on the impact of the interventions on sexual health inequalities due to a lack of relevant data on socioeconomic status, gender and ethnicity. <br/><br/>The results of the economic evaluation were considered to be illustrative, mainly due to the uncertainty of the effect of intervention on behavioural outcomes. The results were most sensitive to changes in parameter values for the intervention effect, the transmission probability of STIs and the number of sexual partners. The costs of teacher-led and peer-led behavioural interventions, based on the resources estimated from the relevant randomised controlled trials in our systematic review, were £4.30 and £15 per pupil, respectively. Teacher-led interventions were more cost-effective than peer-led interventions due to the less frequent need for training. <br/><br/>The incremental cost-effectiveness of the teacher-led and peer-led interventions was £20,223 and £80,782 per quality-adjusted life-year gained, respectively. An analysis of individual parameters revealed that future research funding should focus on assessing the intervention effect for condom use from a school-based intervention.<br/><br/>Conclusions<br/><br/>School-based behavioural interventions for the prevention of STIs in young people can bring about improvements in knowledge and increased self-efficacy, but the interventions did not significantly influence sexual risk-taking behaviour or infection rates. Future investigation should include long-term follow-up to assess the extent to which safer sexual behaviour is adopted and maintained into adulthood, and prospective cohort studies are needed to look at the parameters that describe the transmission of STIs between partners. Funding should focus on the effectiveness of the interventions on influencing behaviour.<br/

Topics: R1
Year: 2010
OAI identifier: oai:eprints.soton.ac.uk:152879
Provided by: e-Prints Soton
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://dx.doi.org/10.3310/hta1... (external link)
  • Suggested articles


    1. (men or man or woman or women or female$or male$or people or person)).
    2. (2004). A et al. HIV health promotion and men who have sex with men (MSM): a systematic review of research relevant to the development and implementation of effective and appropriate interventions. London: EPPI-Centre,
    3. A review of the cost-effectiveness of interventions to prevent sexual transmission of HIV in the United States. doi
    4. (2002). An economic evaluation of a school-based sexually transmitted disease screening program. Sex Transm Dis doi
    5. Applying systematic review methods to studies of people’s views: an example from public health research. doi
    6. attitude to health/or health knowledge, attitudes, practice/ doi
    7. (2002). Behavioral interventions for decreasing HIV infection in racial and ethnic minorities in high-income economies (protocol). Cochrane Database Syst Rev doi
    8. (2000). Cervical cancer and sexual lifestyle: a systematic review of health education interventions targeted at women. Health Educ Res doi
    9. Changing patterns of teenage pregnancy: population based study of small areas. doi
    10. control$or experimental or compar$) adj2 (Group$or trial$or study or studies or evaluat$or condition)).ti,ab.
    11. (2010). Cost-effectiveness of a community-level HIV risk reduction intervention for DOI: doi
    12. Economic evaluation of HIV risk reduction intervention in African-American male adolescents. doi
    13. (2000). Economic evaluation of Safer Choices: a school-based human immunodeficiency virus, other sexually transmitted diseases, and pregnancy prevention program. Arch Pediatr Adolesc Med doi
    14. EPPI-Reviewer© 2.0 (Web edition). EPPICentre Software. London,
    15. Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey [see comment]. doi
    16. exp Acquired Immunodeficiency Syndrome/ doi
    17. exp chancroid/or exp chlamydia infections/ or exp lymphogranuloma venereum/or exp gonorrhea/or exp granuloma inguinale/or exp syphilis/ doi
    18. exp pharmacology, clinical/or exp pharmacology/ doi
    19. exp risk reduction behavior/or exp risk-taking/ or exp condoms/
    20. exp Sex Education/or exp sexology/ doi
    21. exp Sexually Transmitted Diseases, doi
    22. exp surgical procedures, operative/ doi
    23. (2010). for Health and Clinical Excellence. Guide to the methods of technology appraisal.
    24. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. doi
    25. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. doi
    26. (2003). Health inequalities: lifecourse approaches. doi
    27. (2001). Health. Better prevention, better services, better sexual health: the National Strategy for Sexual Health and HIV . doi
    28. (2004). Health. Public Health White Paper. Choosing health: making healthier choices easier. doi
    29. (2003). HIV prevention: a review of reviews assessing the effectiveness of interventions to reduce the risk of sexual transmission. Evidence Briefing. London: Health Development Agency;
    30. (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide [see comment]. doi
    31. Integrating qualitative research with trials in systematic reviews [review; 16 refs].
    32. Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials [comment] [review; 23 refs]. doi
    33. Peer-delivered health promotion for young people: a systematic review of different study designs. doi
    34. (2006). Pregnancy and Social Exclusion: a systematic synthesis of research evidence to identify effective, appropriate and promising approaches for prevention and support. London: EPPI-Centre,
    35. prevent$or reduc$or educat$or promot$or increas$or decreas$or facilitat$or barrier$or encourag$) adj2 (sex$or HIV or STI or STIs or STD$)).ab,kw,ti.
    36. (2007). Preventing and reducing the adverse effects of unintended teenage pregnancies. Effective Health Care Bull doi
    37. Prevention of sexually transmitted infections (STIs): a review of reviews into the effectiveness of nonclinical interventions. Evidence Briefing.
    38. Pupil-led sex education in England (RIPPLE study): cluster-randomised intervention trial [see comment]. doi
    39. Reported sexually transmitted disease clinic attendance and sexually transmitted infections in britain: prevalence, risk factors, and proportionate population burden. doi
    40. (1997). Review guidelines – data collection for the EPIC database. London: EPPICentre;
    41. (1996). Review of effectiveness of health promotion interventions for men who have sex with men.
    42. (1996). Review of effectiveness of sexual health promotion interventions for young people. doi
    43. (2004). Review of guidelines for good practice in decision-analytic modelling in health technology assessment [review; 62 refs]. Health Technol Assess doi
    44. Sexual behaviour in Britain: early heterosexual experience [see comment]. doi
    45. Sexual health education interventions for young people: a methodological review [see comment] [review; 36 refs]. doi
    46. (2001). Systematic reviews in health care: meta analysis in context. London: doi
    47. (2003). Teenage pregnancy and parenthood: a review of reviews. London: Health Development Agency;
    48. (1997). The Black Report and beyond: what are the issues. Soc Sci Med doi
    49. (1994). The transtheoretical model of change and HIV prevention: a review [review; 97 refs]. Health Educ Q doi
    50. (2006). The UK Collaborative Group for HIV and STI Surveillance. A complex Picture - HIV & other sexually transmitted infections in the United Kingdom:
    51. Unit costs of health and social care. Canterbury: Personal Social Service Research Unit;
    52. (2006). Young people and healthy eating: a systematic review of research on barriers and facilitators. Health Educ Res doi
    53. Young people and mental health: a systematic review of research on barriers and facilitators. London: EPPI-Centre, doi

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.