title: Prevention of gonorrhea and Chlamydia through behavioral intervention: results of a two-year controlled randomized trial in minority women.
abstract: BACKGROUND
  Sexually transmitted disease (STD), including AIDS, disproportionately affects African-American and Hispanic women.
  
  
  OBJECTIVE
  To evaluate efficacy of standard and enhanced (addition of optional support groups) gender- and culture-specific, small-group behavioral interventions, compared to interactive STD counseling, in high risk minority women for two years.
  
  
  METHODS
  Women with a non-viral STD were treated and enrolled in a randomized trial. Follow-up screens and interviews occurred at 6 months, 1 year, 18 months (short interview, optional exam) and 2 years. The primary outcome was subsequent infection with chlamydia and/or gonorrhea. Secondary outcomes included risky sexual behaviors. We employed logistic regression based on intention-to-treat.
  
  
  RESULTS
  Data from 775 women were included; the retention rate was 91%. Adjusted infection rates were higher in the controls in Year 1 (26.8%), Year 2 (23.1%), and cumulatively (39.8%) than in the enhanced (15.4%, P = 0.004; 14.8%, P < 0.03; 23.7%, P < 0.001, respectively) and standard (15.7%, P = 0.006; 14.7%, P = 0.03; 26.2%, P < 0.008, respectively) intervention arms at these time points. Enhanced-intervention women who opted to attend support groups (attendees) had the lowest adjusted infection rates in Year 1 (12.0%) and cumulatively (21.8%). Intervention women in general, but particularly attendees, were significantly less likely than controls to have repeat infections. Multiple partners and unprotected sex with an untreated or incompletely treated partner helped explain group differences in infection.
  
  
  CONCLUSIONS
  Risk-reduction interventions significantly decreased both single and multiple infective episodes with chlamydia and/or gonorrhea and risky sexual behaviors in the two-year study period. Support-group attendance appeared to contribute additional risk reduction in Year 1.
authors.affiliation: Department of Obstetrics & Gynecology, Microbiology, and School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio Metropolitan Health District, San Antonio, Texas 78229, USA. shain@uthscsa.edu
authors.forename: Rochelle N
authors.initials: RN
authors.lastname: Shain
authors.forename: Jeanna M
authors.initials: JM
authors.lastname: Piper
authors.forename: Alan E C
authors.initials: AE
authors.lastname: Holden
authors.forename: Jane Dimmitt
authors.initials: JD
authors.lastname: Champion
authors.forename: Sondra T
authors.initials: ST
authors.lastname: Perdue
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Korte
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Guerra
mesh_terms: D000328:Adult; D044383:Black People; D002690:Chlamydia Infections / Q000208:ethnology / Q000517:prevention & control*; D003376:Counseling; D005260:Female; D006069:Gonorrhea / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D017058:Mexican Americans; D012725:Sexual Behavior; D013781:Texas; D016896:Treatment Outcome; D016387:Women's Health; D001741:Black or African American