title: Impact of community-based interventions on condom use in the Tłįcho region of Northwest Territories, Canada.
abstract: BACKGROUND
  Since 2005, the Tłįcho Community Services Agency (TCSA) in Canada's Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI). In 2009, STI rates in the NT were ten times higher than the national rate and Tłįcho regional rates were nearly four times that of the NT--91 cases per 1000 people. We describe a social audit process that assessed the impact of an evidence-based community-led intervention.
  
  
  METHODS
  A baseline survey of sexual health knowledge, attitudes and behaviours in 2006/07 provided evidence for a Community Action Research Team (CART) to develop and to put in place culturally appropriate interventions in the Tłįcho region. A follow-up study in 2010 sought to assess the impact of CART activities on condom use and underlying conscious knowledge, attitudes, subjective norms, intention to change, sense of agency and discussions related to condom use and STI risks. We report the contrasts using Odds Ratios (OR) and 95% confidence intervals (CI).
  
  
  RESULTS
  One in every three follow-up respondents (315/808) participated in at least one CART activity. Participation in highly ranked interventions was associated with increased condom use during the last sexual encounter (OR 1.45, 95%CI 1.07-1.98). Those exposed to three or more activities were more likely to talk openly about condoms (OR 2.08, 95%CI 1.41-3.28), but were also less likely to be monogamous (OR 0.49, 95%CI 0.29-0.90).
  
  
  CONCLUSIONS
  The measurable impact on condom use indicates a strong beginning for the Tłįcho community intervention programmes. The interventions also seem to generate increased discussion, often a precursor to action. The Tłįcho can use the evidence to improve and refocus their programming, increase knowledge and continue to improve safe condom use practices.
authors.affiliation: Universidad Autónoma de Guerrero, Mexico. karenedwards@me.com
authors.forename: Karen E
authors.initials: KE
authors.lastname: Edwards
authors.forename: Nancy
authors.initials: N
authors.lastname: Gibson
authors.forename: Jim
authors.initials: J
authors.lastname: Martin
authors.forename: Steven
authors.initials: S
authors.lastname: Mitchell
authors.forename: Neil
authors.initials: N
authors.lastname: Andersson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services; D017280:Condoms / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015873:Northwest Territories / Q000453:epidemiology; D016017:Odds Ratio; D012111:Residence Characteristics; D012309:Risk-Taking; D019529:Sexuality / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult