Prevention of gonorrhea and Chlamydia through behavioral intervention: results of a two-year controlled randomized trial in minority women.
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.
Shain
Rochelle N
RN
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
Piper
Jeanna M
JM
Holden
Alan E C
AE
Champion
Jane Dimmitt
JD
Perdue
Sondra T
ST
Korte
Jeffrey E
JE
Guerra
Fernando A
FA
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