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Do School-Based Programs Prevent HIV and Other Sexually Transmitted Infections in Adolescents? A Systematic Review and Meta-analysis

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Abstract

We systematically reviewed the literature to assess the effectiveness of school-based programs to prevent HIV and other sexually transmitted infections (STI) among adolescents in the USA. We searched six databases including PubMed for studies published through May 2017. Eligible studies included youth ages 10–19 years and assessed any school-based programs in the USA that reported changes in HIV/STI incidence or testing. We used Cochrane tool to assess the risk of bias and GRADE to determine the evidence quality for each outcome. Three RCTs and six non-RCTs, describing seven interventions, met study inclusion criteria. No study reported changes in HIV incidence or prevalence. One comprehensive intervention, assessed in a non-RCT and delivered to pre-teens, reduced STI incidence into adulthood (RR 0.36, 95% CI 0.23–0.56). A non-RCT examining chlamydia and gonorrhea incidence before and after a condom availability program found a significant effect at the city level among young men 3 years later (RR 0.43, 95% CI 0.23–0.80). The remaining four interventions found no effect. The effect on STI prevalence was also not significant (pooled RR 0.83 from two non-RCTs, RR 0.70 from one RCT). Only one non-RCT showed an increase in HIV testing (RR 3.19, 95% CI 1.24–8.24). The quality of evidence for all outcomes was very low. Studies, including the RCTs, were of low methodological quality and had mixed findings, thus offering no persuasive evidence for the effectiveness of school-based programs. The most effective intervention spanned 6 years, was a social development-based intervention with multiple components, rather than a sex education program, and started in first grade.

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References

  • Brown, J., Sales, J., DiClemente, R., Salazar, L., Vanable, P., Carey, M., & Stanton, B. (2012). Predicting discordance between self-reports of sexual behavior and incident sexually transmitted infections with African American female adolescents: Results from a 4-city study. AIDS and Behavior, 16, 1491–1500. doi:10.1007/s10461-012-0163-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brozek, J., Oxman, A., & Schünemann. (2008). GRADEpro [Computer software]: GRADE Working Group.

  • Centers for Disease Control and Prevention. (2015a). HIV Surveillance Report, 2014; vol. 26. Retrieved from http://www.cdc.gov/hiv/library/reports/surveillance.

  • Centers for Disease Control and Prevention. (2015b). STDs and HIV—CDC Fact Sheet. Retrieved from http://www.cdc.gov/std/hiv/stdfact-std-hiv.htm.

  • Chin, H. B., Sipe, T. A., Elder, R., Mercer, S. L., Chattopadhyay, S. K., Jacob, V., & Santelli, J. (2012). The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the Guide to Community Preventive Services. American Journal of Preventive Medicine, 42, 272–294. doi:10.1016/j.amepre.2011.11.006.

    Article  PubMed  Google Scholar 

  • Clark, L., Brasseux, C., Richmond, D., Getson, P., & D'Angelo, L. (1997). Are adolescents accurate in self-report of frequencies of sexually transmitted diseases and pregnancies? The Journal of Adolescent Health, 21, 91–96.

    Article  CAS  PubMed  Google Scholar 

  • Cochrane (2011). Retrieved from http://training.cochrane.org/calculator.

  • Cochrane (2017a). Retrieved from http://handbook.cochrane.org/chapter_10/10_4_3_1_recommendations_on_testing_for_funnel_plot_asymmetry.htm.

  • Cochrane (2017b). Retrieved from http://handbook.cochrane.org/chapter_8/8_4_introduction_to_sources_of_bias_in_clinical_trials.htm.

  • Cohen, D. A., Nsuami, M., Martin, D. H., & Farley, T. A. (1999). Repeated school-based screening for sexually transmitted diseases: A feasible strategy for reaching adolescents. Pediatrics, 104, 1281–1285.

    Article  CAS  PubMed  Google Scholar 

  • Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Collins, J., et al. (2001). Safer choices: Reducing teen pregnancy, HIV, and STDs. Public Health Reports, 116, 82–93.

    Article  PubMed  PubMed Central  Google Scholar 

  • Coyle KK, Kirby DB, Robin LE, Banspach SW, Baumler E, Glassman JR. All4You! A randomized trial of an HIV, other STDs, and pregnancy prevention intervention for alternative school students. AIDS Education and Prevention 2006 Jun;18(3):187-203. PubMed PMID:16774462.

  • EndNote Corp. (2013). [Computer software] EndNote X7: Thomson Reuters. Retrieved from http://endnote.com/product-details/X7

  • Fewell, Z., Davey Smith, G., & Sterne, J. (2007). The impact of residual and unmeasured confounding in epidemiologic studies: A simulation study. American Journal of Epidemiology, 166, 646–655.

    Article  PubMed  Google Scholar 

  • Fonner, V. A., Armstrong, K. S., Kennedy, C. E., O’Reilly, K. R., & Sweat, M. D. (2014). School based sex education and HIV prevention in low- and middle-income countries: A systematic review and meta-analysis. PloS One, 9, e89692. doi:10.1371/journal.pone.0089692.

    Article  PubMed  PubMed Central  Google Scholar 

  • Glassman, J., Coyle, K., Anderson, P., & Baumler, E. (2014). Accuracy of self-report measures of sexual behaviors among middle school students: Association between lying on surveys and peer norms. Abstract retrieved from Society for Prevention Research: 22nd Annual Meeting Abstracts database.

  • Goesling, B., Colman, S., Trenholm, C., Terzian, M., & Moore, K. (2014). Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: A systematic review. The Journal of Adolescent Health, 54, 499–507. doi:10.1016/j.jadohealth.2013.12.004.

    Article  PubMed  Google Scholar 

  • Guyatt, G. H., Oxman, A. D., Schunemann, H. J., Tugwell, P., & Knottnerus, A. (2011). GRADE guidelines: A new series of articles in the journal of clinical epidemiology. Journal of Clinical Epidemiology, 64, 380–382. doi:10.1016/j.jclinepi.2010.09.011.

    Article  PubMed  Google Scholar 

  • Hale, D. R., Fitzgerald-Yau, N., & Viner, R. M. (2014). A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence. American Journal of Public Health, 104, e19–e41. doi:10.2105/ajph.2014.301874.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hawkins, J. D., Kosterman, R., Catalano, R. F., Hill, K. G., & Abbott, R. D. (2008). Effects of social development intervention in childhood 15 years later. Archives of Pediatrics & Adolescent Medicine, 162, 1133–1141. doi:10.1001/archpedi.162.12.1133.

    Article  Google Scholar 

  • Higgins, J. (2011). Cochrane handbook for systematic reviews of interventions, Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from www.cochrane-handbook.org .

  • Higgins, J., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions (J. Higgins & S. Green Eds. 5.1.0 ed.): The Cochrane Collaboration.

  • Higgins, J., Altman, D., & Sterne, J. (2011). Assessing risk of bias in included studies In J. Higgins & S. Green (Eds.), Cochrane handbook for systematic reviews of interventions (Version 5.1.0 ed.): The Cochrane Collaboration.

  • Hill, K. G., Bailey, J. A., Hawkins, J. D., Catalano, R. F., Kosterman, R., Oesterle, S., & Abbott, R. D. (2014). The onset of STI diagnosis through age 30: Results from the Seattle Social Development Project intervention. Prevention Science, 15, S19–S32. doi:10.1007/s11121-013-0382-x.

    Article  PubMed  Google Scholar 

  • Johnson, B. T., Scott-Sheldon, L. A., Huedo-Medina, T. B., & Carey, M. P. (2011). Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: A meta-analysis of trials, 1985-2008. Archives of Pediatrics & Adolescent Medicine, 165, 77–84. doi:10.1001/archpediatrics.2010.251.

    Google Scholar 

  • Kane, R. L., Wang, J., & Garrard, J. (2007). Reporting in randomized clinical trials improved after adoption of the CONSORT statement. Journal of Clinical Epidemiology, 60, 241–249. doi:10.1016/j.jclinepi.2006.06.016.

    Article  PubMed  Google Scholar 

  • Kicinski, M. (2013). Publication bias in recent meta-analyses. PloS One, 11, e81823.

    Article  Google Scholar 

  • Kirby, D. (2002). The impact of schools and school programs upon adolescent sexual behavior. Journal of Sex Research, 39, 27–33.

    Article  PubMed  Google Scholar 

  • Kirby, D. B., & Brown, N. L. (1996). Condom availability programs in U.S. schools. Family Planning Perspectives, 28, 196–202.

    Article  CAS  PubMed  Google Scholar 

  • Kirby, D., Korpi, M., Adivi, C., & Weissman, J. (1997). An impact evaluation of project SNAPP: An AIDS and pregnancy prevention middle school program. AIDS Education and Prevention, 9, 44–61.

    CAS  PubMed  Google Scholar 

  • Lemieux, A. F., Fisher, J. D., & Pratto, F. (2008). A music-based HIV prevention intervention for urban adolescents. Health Psychology, 27, 349–357. doi:10.1037/0278-6133.27.3.349.

    Article  PubMed  Google Scholar 

  • Lonczak, H. S., Abbott, R. D., Hawkins, J. D., Kosterman, R., & Catalano, R. F. (2002). Effects of the Seattle social development project on sexual behavior, pregnancy, birth, and sexually transmitted disease outcomes by age 21 years. Archives of Pediatrics & Adolescent Medicine, 156, 438–447.

    Article  Google Scholar 

  • Mason-Jones, A. J., Crisp, C., Momberg, M., Koech, J., De Koker, P., & Mathews, C. (2012). A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. Systematic Reviews, 1, 1–12. doi:10.1186/2046-4053-1-49.

    Article  Google Scholar 

  • Mavedzenge, S. N., Luecke, E., & Ross, D. A. (2014). Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: A systematic review of systematic reviews. Journal of Acquired Immune Deficiency Syndromes, 66, S154–S169. doi:10.1097/QAI.0000000000000178.

    Article  PubMed  Google Scholar 

  • National Center for Education Statistics. (2015). Current population survey. Retrieved from https://nces.ed.gov/programs/coe/.

  • Oringanje, C., Meremikwu, M. M., Eko, H., Esu, E., Meremikwu, A., & Ehiri, J. E. (2009). Interventions for preventing unintended pregnancies among adolescents. The Cochrane Database of Systematic Reviews, (4), Cd005215. doi:10.1002/14651858.CD005215.pub2

  • Oringanje, C., Meremikwu, M., Eko, H., Esu, E., Meremikwu, A., & Ehiri, J. (2016). Interventions for preventing unintended pregnancies among adolescents. The Cochrane Database of Systematic Reviews, 2, Cd005215.

  • Paul-Ebhohimhen, V. A., Poobalan, A., & van Teijlingen, E. R. (2008). A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa. BMC Public Health, 8, 4. doi:10.1186/1471-2458-8-4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Picot, J., Shepherd, J., Kavanagh, J., Cooper, K., Harden, A., Barnett-Page, E., et al. (2012). Behavioural interventions for the prevention of sexually transmitted infections in young people aged 13-19 years: A systematic review. Health Education Research, 27, 495–512. doi:10.1093/her/cys014.

    Article  PubMed  Google Scholar 

  • PROSPERO. (2016). International prospective register of systematic reviews. Retrieved from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016033007

  • Spoth, R., Redmond, C., Shin, C., Greenberg, M. T., Feinberg, M. E., & Trudeau, L. (2017). PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors. Psychological Medicine, 1–14. doi:10.1017/s0033291717000691

  • Underhill, K., Montgomery, P., & Operario, D. (2008). Abstinence-plus programs for HIV infection prevention in high-income countries. The Cochrane Database of Systematic Reviews, 1, CD007006. doi:10.1002/14651858.CD007006.

    Google Scholar 

  • Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gotzsche, P. C., & Vandenbroucke, J. P. (2014). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. International Journal of Surgery, 12, 1495–1499. doi:10.1016/j.ijsu.2014.07.013.

    Article  Google Scholar 

  • Walter, H. J., & Vaughan, R. D. (1993). AIDS risk reduction among a multiethnic sample of urban high school students. The Journal of the American Medical Association, 270, 725–730.

    Article  CAS  PubMed  Google Scholar 

  • Wretzel, S. R., Visintainer, P. F., & Pinkston Koenigs, L. M. (2011). Condom availability program in an inner city public school: Effect on the rates of gonorrhea and chlamydia infection. The Journal of Adolescent Health, 49, 324–326. doi:10.1016/j.jadohealth.2010.12.011.

    Article  PubMed  Google Scholar 

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Correspondence to Ali Mirzazadeh.

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This project was completed as part of Consortium for Assessment of Prevention Economics (CAPE), of Cooperative Agreement (Grant No: U38PS004649), NEEMA, with the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Mirzazadeh, A., Biggs, M.A., Viitanen, A. et al. Do School-Based Programs Prevent HIV and Other Sexually Transmitted Infections in Adolescents? A Systematic Review and Meta-analysis. Prev Sci 19, 490–506 (2018). https://doi.org/10.1007/s11121-017-0830-0

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