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## Complete Summary

#### GUIDELINE TITLE

One to one interventions to reduce the transmission of sexually
transmitted infections (STIs) including HIV, and to reduce the rate of
under 18 conceptions, especially among vulnerable and at risk groups.

#### BIBLIOGRAPHIC SOURCE(S)

National Institute for Health and Clinical Excellence (NICE). One to one
interventions to reduce the transmission of sexually transmitted
infections (STIs) including HIV, and to reduce the rate of under 18
conceptions, especially among vulnerable and at risk groups. London
(UK): National Institute for Health and Clinical Excellence (NICE); 2007
Feb. 50 p. (Public health intervention guidance; no. 3). \[15
references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

In March 2010, these recommendations will be reviewed and the state of
the evidence base at that time will be reassessed. A decision will then
be made about whether it is appropriate to update the guidance. If it is
not updated at that time, the situation will be reviewed again in March
2012.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Chlamydia and other sexually transmitted infections (STIs),
    including human immunodeficiency virus (HIV)

-   Conceptions in vulnerable young people aged under 18

#### GUIDELINE CATEGORY

Assessment of Therapeutic Effectiveness\
Counseling\
Prevention

#### CLINICAL SPECIALTY

Family Practice\
Infectious Diseases\
Internal Medicine\
Nursing\
Obstetrics and Gynecology\
Pediatrics\
Preventive Medicine\
Urology

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Hospitals\
Nurses\
Physician Assistants\
Physicians\
Public Health Departments

#### GUIDELINE OBJECTIVE(S)

To produce public health guidance on interventions to reduce the
transmission of chlamydia (including screening) and other sexually
transmitted infections (including human immunodeficiency virus) and to
reduce the rate of under 18 conceptions, especially among vulnerable and
at risk groups

#### TARGET POPULATION

Vulnerable young people aged under 18. This may include young people:

-   From disadvantaged backgrounds

-   Who are in -- or leaving -- care

-   Who have low educational attainment

Key groups at risk of sexually transmitted infections (STIs) including:

-   Men who have sex with men

-   People who have come from or who have visited areas of high human
    immunodeficiency virus (HIV) prevalence

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Identification of individuals at high risk of sexually transmitted
    infections (STIs)

2.  Structured discussion with patients at high risk of STIs

3.  Partner notification and treatment for patients with STIs (referral
    to specialist if necessary)

4.  Provision of infection specific information

    -   Home sampling kit for Chlamydia

5.  Provide sexual health advice

    -   Prevention and testing for STIs

    -   Prevention of unwanted pregnancies

    -   All methods of reversible contraception

    -   Other reproductive issues

    -   Health promotion advice (for young women under 18 who are
        pregnant or already mothers)

    -   Opportunities for returning to education, training and
        employment (for young women under 18 who are pregnant or already
        mothers)

    -   Referral to relevant agencies including services for
        reintegration into education and work (for young women under 18
        who are pregnant or already mothers)

6.  Ensure that sexual health services, including contraceptive and
    abortion services, are in place to meet local needs

#### MAJOR OUTCOMES CONSIDERED

-   Reductions in the under 18 conceptions

-   Prevalence and incidence of Chlamydia and female reproductive tract
    morbidity

-   Incidence and prevalence of sexually transmitted infections
    including human immunodeficiency virus (patient and index patient),
    number of partners contacted, tested and treated

-   Cost-effectiveness

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

**Key Questions**

Key questions were established as part of the scope. They formed the
starting point for the reviews of evidence and facilitated the
development of recommendations by the Public Health Interventions
Advisory Committee (PHIAC). Refer to appendix D in the original
guideline document for a list of key questions.

**Evidence of Effectiveness**

Three reviews of effectiveness were conducted:

-   Review 1 \"Contraceptive advice and provision for the prevention of
    under 18 conceptions and sexually transmitted infections: a rapid
    review\"

-   Review 2 \"Review of evidence for the effectiveness of screening for
    genital chlamydial infection in sexually active young women and
    men\"

-   Review 3 \"Review of evidence for the effectiveness of partner
    notification for sexually transmitted infections (STIs) including
    human immunodeficiency virus (HIV)\"

**Identifying the Evidence**

The following core databases were searched for randomised controlled
trials, controlled before/after studies and qualitative studies (process
only): Medline, Embase, Psychinfo, DARE and Sigle from 1990--2005.
Reference lists from included studies were hand searched.

Further details of databases, search terms and strategies are included
in the review reports.

**Selection Criteria**

Inclusion and exclusion criteria for each review varied and details can
be found at:
[http://guidance.nice.org.uk](http://guidance.nice.org.uk/page.aspx?o=518566)

However, in general:

-   Review 1 included one to one interventions which offered
    information, advice, condoms, counselling, cognitive behavioural
    therapy and/or activities that increase self-confidence, self-esteem
    and skill development

-   Review 2 considered any activity described as screening or where
    testing for chlamydia was offered to asymptomatic sexually active
    adults

-   Review 3 considered any intervention described as partner
    notification or contact tracing, or where partners were located and
    informed that they have been exposed to an infection

-   Studies in both National Health Service (NHS) and non-health
    settings were considered. Details of the studies that were excluded
    can be found in the reviews.

**Economic Appraisal**

The economic appraisal consisted of a review of economic evaluations and
a cost-effectiveness analysis.

**Review of Economic Evaluations**

A systematic search was carried out on four databases from January 1990
to December 2005: Econlit, NHS HEED, NEED, DARE. The results of these
searches were supplemented by results from the parallel effectiveness
reviews and additional papers identified by NICE. The main inclusion
criteria were:

-   Studies focused on one to one interventions

-   Studies set in countries in Europe, US, Canada and Australia

-   Studies set in prison, army, primary care and secondary care
    settings

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Study Type**

-   Meta-analyses, systematic reviews of randomised clinical trials
    (RCTs) or RCTs (including cluster RCTs).

-   Systematic reviews of, or individual, non-randomised controlled
    trials, case-control studies, cohort studies, controlled
    before-and-after studies, interrupted time series studies,
    correlation studies.

-   Non-analytical studies (for example, case reports, case series).

-   Expert opinion, formal consensus.

**Study Quality**

**++** All or most of the criteria have been fulfilled. Where they have
not been fulfilled the conclusions are thought very unlikely to alter.

**+** Some criteria have been fulfilled. Those criteria that have not
been fulfilled or not adequately described are thought unlikely to alter
the conclusions.

**--** Few or no criteria fulfilled. The conclusions of the study are
thought likely or very likely to alter.

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

**Quality Appraisal**

Included papers were assessed for methodological rigour and quality
using the National Institute for Health and Clinical Excellence (NICE)
methodology checklist, as set out in the NICE technical manual \'Methods
for development of NICE public health guidance\' (see \"Availability of
Companion Documents\" field in this summary). Each study was described
by study type and graded (++, +, -) to reflect the risk of potential
bias arising from its design and execution.

The studies were also assessed for their applicability to the UK.

**Summarizing the Evidence and Making Evidence Statements**

Data from the reviews was summarised in evidence tables (see full
reviews and the synopsis). Outcomes of interest included:

-   Review 1: reductions in under 18 teenage conceptions and sexually
    transmitted infections (STIs) including human immunodeficiency virus
    (HIV) (primary outcomes), and increased condom use, improved sexual
    health knowledge, and a reduction in the number of sexual partners
    and general sexual risk taking (intermediate outcomes)

-   Review 2: reduction in the prevalence and incidence of chlamydia and
    female reproductive tract morbidity

-   Review 3: reduction in the incidence and prevalence of STI (patient
    and index patient), increase in number of partners contacted, tested
    and treated.

The findings from the reviews were synthesised and used as the basis for
a number of evidence statements relating to each key question. The
evidence statements reflect the strength (quantity, type and quality) of
evidence and its applicability to the populations and settings in the
scope.

**Economic Appraisal**

Included studies were assessed for quality using a checklist based on
the criteria developed by Drummond et al. Studies were then given a
score (++, +, -) to reflect the risk of potential bias arising from its
design and execution. The evidence tables for the cost-effectiveness
review are included in the review (see appendix E in the original
guideline document).

**Cost-Effectiveness Analysis**

Economic models were constructed to incorporate data from the reviews of
effectiveness and cost effectiveness. The results are reported in
\'Public Health Interventions Advisory Committee (PHIAC) 6.7 economic
modelling report\' (University of Birmingham) and \'PHIAC 6.10 economic
modelling report\' (NERA consultancy). They are available on the NICE
website at:
[http://guidance.nice.org.uk](http://guidance.nice.org.uk/page.aspx?o=518566).

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Informal Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

**How Public Health Interventions Advisor Committee (PHIAC) Formulated
the Recommendations**

At its meetings in May 2006 and September 2006 PHIAC considered the
evidence of effectiveness and cost effectiveness. In addition, at its
meeting in December 2006, it considered comments from stakeholders and
the results from fieldwork to determine:

-   Whether there was sufficient evidence (in terms of quantity, quality
    and applicability) to form a judgement

-   Whether, on balance, the evidence demonstrates that the intervention
    is effective or ineffective, or whether it is equivocal

-   Where there is an effect, the typical size of effect

PHIAC developed draft recommendations through informal consensus, based
on the following criteria.

-   Strength (quality and quantity) of evidence of effectiveness and its
    applicability to the populations/settings referred to in the scope

-   Effect size and potential impact on population health and/or
    reducing inequalities in health

-   Cost effectiveness (for the National Health Service and other public
    sector organisations)

-   Balance of risks and benefits

-   Ease of implementation and the anticipated extent of change in
    practice that would be required

Where possible, recommendations were linked to an evidence statement(s)
(see appendix A in the original guideline document for details). Where a
recommendation was inferred from the evidence, this was indicated by the
reference \'IDE\' (inference derived from the evidence).

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

**Cost-Effectiveness Evidence**

Overall, one to one interventions were found to be cost effective. The
results of the cost-effectiveness analysis are summarised below.

**Sexually Transmitted Infection (STI) Counselling Interventions**

Most of the brief STI counselling interventions appear cost effective
when compared with \'usual treatment\' (using £30,000 per QALY as the
threshold). The incremental analysis demonstrated that brief
interventions involving information giving or developing motivation and
behavioural skills (particularly among women) produce the greatest
benefits for the least cost. More intensive behavioural skills
counselling and enhanced counselling appear to be least cost effective.
These analyses apply to the general population, including vulnerable
young women.

In the absence of data, no costs were attributed to \'usual treatment\'.
As a result, when interventions are compared against usual treatment the
cost difference may be overestimated and the incremental
cost-effectiveness ratios may be artificially high.

The loss of quality of life (QALYs lost) is particularly important in
the analysis. The cost per QALY may be high (if low values are assigned
to the change in quality of life) but brief STI counselling falls below
a £30,000 per QALY threshold (based on 0.1 of a QALY change).

**Partner Notifications at General Practitioner (GP) Clinics**

Partner notification by a practice nurse in a general practice costs the
same as in a genitourinary medicine setting -- but more patients can be
treated in a GP setting.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

The draft guidance, including the recommendations, was released for
consultation in October and November 2006. The guidance was signed off
by the National Institute for Health and Clinical Excellence (NICE)
Guidance Executive in February 2007.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

This document constitutes the Institute\'s formal guidance on one to one
interventions to prevent sexually transmitted infections (STIs) and
under 18 conceptions. The recommendations in this section are presented
without any reference to evidence statements. Appendix A in the original
guideline document repeats the recommendations and lists their linked
evidence statements.

**Recommendation 1**

**Who is the target population?**

Key groups at risk of STIs including:

-   Men who have sex with men

-   People who have come from or who have visited areas of high human
    immunodeficiency virus (HIV) prevalence

Behaviours that increase the risk of STIs include:

-   Misuse of alcohol and/or substances

-   Early onset of sexual activity

-   Unprotected sex and frequent change of and/or multiple sexual
    partners

**Who should take action?**

Health professionals working in:

-   General practice

-   Genito-urinary medicine (GUM)

-   Community health services (including community contraceptive
    services)

-   Voluntary and community organisations

-   School clinics

**What action should they take?**

-   Identify individuals at high risk of STIs using their sexual
    history. Opportunities for risk assessment may arise during
    consultations on contraception, pregnancy or abortion, and when
    carrying out a cervical smear test, offering an STI test or
    providing travel immunisation. Risk assessment could also be carried
    out during routine care or when a new patient registers.

-   Have one to one structured discussions with individuals at high risk
    of STIs (if trained in sexual health), or arrange for these
    discussions to take place with a trained practitioner.

**Recommendation 2**

**Who is the target population?**

Key groups at risk of STIs including:

-   Men who have sex with men

-   People who have come from or who have visited areas of high HIV
    prevalence

Behaviours that increase the risk of STIs include:

-   Misuse of alcohol and/or substances

-   Early onset of sexual activity

-   Unprotected sex and frequent change of and/or multiple sexual
    partners

**Who should take action?**

Health professionals trained in sexual health who work in:

-   General practice

-   GUM

-   Community health services (including community contraceptive
    services)

-   Voluntary and community organisations

-   School clinics

**What action should they take?**

-   Have one to one structured discussions with individuals at high risk
    of STIs. The discussions should be structured on the basis of
    behaviour change theories. They should address factors that can help
    reduce risk-taking and improve self-efficacy and motivation.
    Ideally, each session should last at least 15--20 minutes. The
    number of sessions will depend on individual need.

-   For details of a range of behaviour change theories see *Predicting
    Health Behaviour* by Mark Conner and Paul Norman.

**Recommendation 3**

**Who is the target population?**

Patients with an STI

**Who should take action?**

-   Health professionals working in general practice, GUM and community
    health services (including community contraceptive services),
    voluntary and community organisations and school clinics. (However,
    they may need to refer the patient to a specialist.)

-   Specialists with responsibility for helping to contact, test and
    treat partners of patients with an STI (partner notification). They
    may be sexual health advisers, general practitioners or practice
    nurses providing enhanced sexual health services, chlamydia
    screening coordinators or GUM clinicians.

**What action should they take?**

-   Help patients with an STI to get their partners tested and treated
    (partner notification), when necessary. This support should be
    tailored to meet the patient\'s individual needs.

-   If necessary, refer patients to a specialist with responsibility for
    partner notification. (Partner notification may be undertaken by the
    health professional or by the patient.)

-   Provide the patient and their partners with infection-specific
    information, including advice about possible re-infection. For
    chlamydia infection, also consider providing a home sampling kit.

**Recommendation 4**

**Who is the target population?**

Population served by a Primary Care Trust (PCT)

**Who should take action?**

PCT commissioners

**What action should they take?**

-   Ensure that sexual health services, including contraceptive and
    abortion services, are in place to meet local needs. All services
    should include arrangements for the notification, testing, treatment
    and follow-up of partners of people who have an STI (partner
    notification).

-   Define the role and responsibility of each service in relation to
    partner notification (including referral pathways).

-   Ensure staff are trained.

-   Ensure there is an audit and monitoring framework in place.

**Recommendation 5**

**Who is the target population?**

Vulnerable young people aged under 18. This may include young people:

-   From disadvantaged backgrounds

-   Who are in -- or leaving -- care

-   Who have low educational attainment

For a more detailed definition of vulnerable young people see Department
for Education and Skills (2006) \"Teenage Pregnancy: Accelerating the
Strategy to 2010.\"

**Who should take action?**

-   GPs, nurses and other clinicians working in healthcare settings such
    as primary care, community contraceptive services, antenatal and
    postnatal care, abortion and GUM services, drug/alcohol misuse and
    youth clinics, and pharmacies

-   GPs, nurses and other clinicians working in non-healthcare settings
    such as schools and other education and outreach centres

**What action should they take?**

-   Where appropriate, provide one to one sexual health advice on:

    -   How to prevent and/or get tested for STIs and how to prevent
        unwanted pregnancies

    -   All methods of reversible contraception, including long-acting
        reversible contraception (LARC) (in line with National Institute
        for Health and Clinical Excellence (NICE) clinical guideline 30)

    -   How to get and use emergency contraception

    -   Other reproductive issues and concerns

-   Provide supporting information on the above in an appropriate
    format.

**Recommendation 6**

**Who is the target population?**

Vulnerable young women aged under 18 who are pregnant or who are already
mothers. This may include young women:

-   From disadvantaged backgrounds

-   Who are in -- or leaving -- care

-   Who have low educational attainment

For a more detailed definition of vulnerable young people see Department
for Education and Skills (2006) \"Teenage Pregnancy: Accelerating the
Strategy to 2010.\"

**Who should take action?**

-   Midwives and health visitors who provide antenatal, postnatal and
    child development services

**What action should they take?**

-   Regularly visit vulnerable women aged under 18 who are pregnant or
    who are already mothers.

-   Discuss with them and their partner (where appropriate) how to
    prevent or get tested for STIs and how to prevent unwanted
    pregnancies. The discussion should cover:

    -   All methods of reversible contraception, including LARC (in line
        with NICE clinical guideline 30), and how to get and use
        emergency contraception

    -   Health promotion advice, in line with NICE guidance on postnatal
        care (NICE clinical guideline 37)

    -   Opportunities for returning to education, training and
        employment in the future

-   Provide supporting information in an appropriate format.

-   Where appropriate, refer the young woman to the relevant agencies,
    including services concerned with reintegration into education and
    work.

#### CLINICAL ALGORITHM(S)

The original guideline document contains a clinical algorithm for one to
one interventions to prevent STIs and under 18 conceptions.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type and quality of supporting evidence is identified and graded for
each recommendation (see Appendix A in the original guideline document).

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate use of interventions to prevent sexually transmitted
infections and under 18 conceptions

#### POTENTIAL HARMS

Not stated

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

The Healthcare Commission assesses the performance of National Health
Service organisations in meeting core and developmental standards set by
the Department of Health (DH) in \'Standards for better health\' issued
in July 2004. The implementation of National Institute for Health and
Clinical Excellence (NICE) public health guidance will help
organisations meet the standards in the public health (seventh) domain
in \'Standards for better health\'. These include the core standards
numbered C22 and C23 and the developmental standard D13. In addition,
implementation of NICE public health guidance will help meet the health
inequalities target as set out in \'The NHS in England: the operating
framework for 2006/7\'.

NICE has developed tools to help organisations implement this guidance.
The tools will be available on our website
([www.nice.org.uk/PHI003](http://www.nice.org.uk/PHI003)).

-   Costing tools:

    -   Costing report to estimate the national savings and costs
        associated with implementation

    -   Costing template to estimate the local costs and savings
        involved

-   Slides highlighting key messages for local discussion

-   Practical advice on how to implement the guidance and details of
    national initiatives that can provide support

-   Audit criteria to monitor local practice

#### IMPLEMENTATION TOOLS

Audit Criteria/Indicators\
Clinical Algorithm\
Quick Reference Guides/Physician Guides\
Resources\
Slide Presentation

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

National Institute for Health and Clinical Excellence (NICE). One to one
interventions to reduce the transmission of sexually transmitted
infections (STIs) including HIV, and to reduce the rate of under 18
conceptions, especially among vulnerable and at risk groups. London
(UK): National Institute for Health and Clinical Excellence (NICE); 2007
Feb. 50 p. (Public health intervention guidance; no. 3). \[15
references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2007 Feb

#### GUIDELINE DEVELOPER(S)

National Institute for Health and Clinical Excellence (NICE) - National
Government Agency \[Non-U.S.\]

#### SOURCE(S) OF FUNDING

National Institute for Health and Clinical Excellence (NICE)

#### GUIDELINE COMMITTEE

NICE Project Team\
Public Health Interventions Advisory Committee (PHIAC)

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*NICE Project Team Members*: Mike Kelly, CPHE Director; Antony Morgan,
Associate Director; Geraldine McCormick, Analyst; Amanda Killoran,
Analyst; Bhash Naidoo, Technical Adviser (Health Economics)

*Public Health Interventions Advisory Committee (PHIAC) Members*: Mrs
Cheryll Adams, Professional Officer for Research and Practice
Development with the Community Practitioners\' and Health Visitors\'
Association (CPHVA); Professor Sue Atkinson, CBE Independent Consultant
and Visiting Professor in the Department of Epidemiology and Public
Health, University College London; Professor Michael Bury, Emeritus
Professor of Sociology at the University of London and Honorary
Professor of Sociology at the University of Kent; Professor Simon
Capewell, Chair of Clinical Epidemiology, University of Liverpool;
Professor K K Cheng, Professor of Epidemiology, University of
Birmingham; Mr Philip Cutler, Forums Support Manager, Bradford Alliance
on Community Care; Professor Brian Ferguson, Director of the Yorkshire
and Humber Public Health Observatory; Professor Ruth Hall, Regional
Director, Health Protection Agency, South West; Ms Amanda Hoey,
Director, Consumer Health Consulting Limited; Mr Andrew Hopkin, Senior
Assistant Director for Derby City Council; Dr Ann Hoskins, Deputy
Regional Director of Public Health for NHS North West; Ms Muriel James,
Secretary for the Northampton Healthy Communities Collaborative and the
King Edward Road Surgery Patient Participation Group; Professor David R
Jones, Professor of Medical Statistics in the Department of Health
Sciences, University of Leicester; Dr Matt Kearney, General
Practitioner, Castlefields, Runcorn and GP Public Health Practitioner,
Knowsley; Ms Valerie King, Designated Nurse for Looked After Children
for Northampton PCT, Daventry and South Northants PCT and Northampton
General Hospital, Public Health Skills Development Nurse for Northampton
PCT; Dr Catherine Law (*Chair*) Reader in Children\'s Health, Institute
of Child Health, University College London; Ms Sharon McAteer, Health
Promotion Manager, Halton PCT; Professor Klim McPherson, Visiting
Professor of Public Health Epidemiology, Department of Obstetrics and
Gynaecology, University of Oxford; Professor Susan Michie, Professor of
Health Psychology, BPS Centre for Outcomes Research & Effectiveness,
University College London; Dr Mike Owen, General Practitioner, William
Budd Health Centre, Bristol; Ms Jane Putsey, Lay Representative, Chair
of Trustees of the Breastfeeding Network; Dr Mike Rayner, Director of
British Heart Foundation Health Promotion Research Group, Department of
Public Health, University of Oxford; Mr Dale Robinson, Chief
Environmental Health Officer, South Cambridgeshire District Council;
Professor Mark Sculpher, Professor of Health Economics at the Centre for
Economics (CHE), University of York; Dr David Sloan, Retired Director of
Public Health; Dr Dagmar Zeuner, Consultant in Public Health, Islington
PCT

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

All members of the Public Health Interventions Advisory Committee are
required to make an oral declaration all potential conflicts of interest
at the start of the consideration of each public health intervention
appraisal. These declarations will be minuted and published on the
National Institute for Health and Clinical Excellence (NICE) website.

Members are required to provide in writing an annual statement of
current conflicts of interests, in accordance with the Institute\'s
policy and procedures.

Potential members of the Public Health Programme Development Groups
(PDG), and any individuals having direct input into the guidance
(including expert peer reviewers), should provide a formal written
declaration of personal interests. A standard form has been developed
for this purpose which also includes the Institute\'s standard policy
for declaring interests. This declaration of interest form should be
completed before any decision about the involvement of an individual is
taken.

Any changes to a Group member\'s declared conflicts of interests should
also be recorded at the start of each PDG meeting. The PDG Chair should
determine whether these interests are significant.

If a member of the PDG has a possible conflict of interest with only a
limited part of the guidance development or recommendations, that member
may continue to be involved in the overall process but should withdraw
from involvement in the area of possible conflict. This action should be
documented and be open to external review. If it is considered that an
interest is significant in that it could impair the individual\'s
objectivity throughout the development of public health guidance, he or
she should not be invited to join the group.

#### GUIDELINE STATUS

This is the current release of the guideline.

In March 2010, these recommendations will be reviewed and the state of
the evidence base at that time will be reassessed. A decision will then
be made about whether it is appropriate to update the guidance. If it is
not updated at that time, the situation will be reviewed again in March
2012.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) format
from the [National Institute for Health and Clinical Excellence (NICE)
Web
site](http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11377).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Prevention of sexually transmitted infections and under 18
    conceptions. Quick reference guide. London (UK): National Institute
    for Health and Clinical Excellence (NICE); 2007 Feb. 6 p. (Public
    Health Intervention Guidance 3). Available in Portable Document
    Format (PDF) from the [National Institute for Health and Clinical
    Excellence (NICE) Web
    site](http://guidance.nice.org.uk/PHI3/quickrefguide/pdf/English).

-   Costing template: one to one interventions to reduce the
    transmission of sexually transmitted infections (STIs) including HIV
    and to reduce the rate of under 18 conceptions especially among
    vulnerable and at risk groups. London (UK): National Institute for
    Health and Clinical Excellence (NICE); 2007 Feb. Various p. (Public
    Health Intervention Guidance 3). Available in Portable Document
    Format (PDF) from the [NICE Web
    site](http://www.nice.org.uk/page.aspx?o=409946).

-   Costing report: one to one interventions to reduce the transmission
    of sexually transmitted infections (STIs) including HIV and to
    reduce the rate of under 18 conceptions especially among vulnerable
    and at risk groups. London (UK): National Institute for Health and
    Clinical Excellence (NICE); 2007 Feb. 36 p. (Public Health
    Intervention Guidance 3). Available in Portable Document Format
    (PDF) from the [NICE Web
    site](http://www.nice.org.uk/page.aspx?o=409954).

-   Slide set: one to one interventions to reduce the transmission of
    sexually transmitted infections (STIs) including HIV, and to reduce
    the rate of under 18 conceptions, especially among vulnerable and at
    risk groups. London (UK): National Institute for Health and Clinical
    Excellence (NICE); 2007 May. 26 p. (Public Health Intervention
    Guidance 3). Available in Portable Document Format (PDF) from the
    [NICE Web site](http://www.nice.org.uk/page.aspx?o=425374).

-   Implementation advice: one to one interventions to reduce the
    transmission of sexually transmitted infections (STI)s including
    HIV, and to reduce the rate of under 18 conceptions, especially
    among vulnerable and at risk groups. London (UK): National Institute
    for Health and Clinical Excellence (NICE); 2007 May. 22 p. (Public
    Health Intervention Guidance 3). Available in Portable Document
    Format (PDF) from the [NICE Web
    site](http://guidance.nice.org.uk/page.aspx?o=428406).

-   Audit criteria: one to one interventions to reduce the transmission
    of sexually transmitted infections (STI)s including HIV, and to
    reduce the rate of under 18 conceptions, especially among vulnerable
    and at risk groups. London (UK): National Institute for Health and
    Clinical Excellence (NICE); 2007 Apr. 17 p. (Public Health
    Intervention Guidance 23). Available from the [NICE Web
    site](http://guidance.nice.org.uk/page.aspx?o=428409).

-   Methods for development of NICE public health guidance. London (UK):
    National Institute for Health and Clinical Excellence (NICE); 2006
    Mar. 131 p. Electronic copies: Available in Portable Document Format
    (PDF) from the [NICE Web
    site](http://www.nice.org.uk/page.aspx?o=299970).

Print copies: Available from the National Health Service (NHS) Response
Line 0870 1555 455. ref: N1186. 11 Strand, London, WC2N 5HR.

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on June 18, 2007. The information was
verified by the guideline developer on July 16, 2007.

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