STI/HIV Prevention Intervention for Adolescents in Singapore
Condition: Sexually Transmitted Infections
MeSH terms: Sexually Transmitted Diseases
Study type: Interventional

Summary: 
      A randomized controlled trial conducted on 688 sexually experienced adolescents, with 337
      participants assigned to the routine program, and 351 to the new intervention developed from
      an assessment of their needs. All participants will complete a self-administered
      questionnaire and an interview on their knowledge of sexually transmitted infections
      (STIs)/Human Immunodeficiency Virus (HIV), self-efficacy, skills in negotiating for sexual
      abstinence or condom use, and sexual behaviors at baseline and at 6- and 12-months' post-
      intervention. All will be tested for STIs. Participants in the intervention group will
      receive 4 individual counseling sessions on STIs/HIV knowledge, life skills, secondary
      abstinence, safer sex and healthy relationships over 1 year. They will also be referred to
      counselors for proactive social and emotional support delivered through electronic media and
      other means. The control group will receive the usual counseling session at first and
      follow-up clinic visit.
    

Detailed description: 
      The reasons for conducting this study in a clinical setting is threefold.

        1. This is group of adolescents that has a high risk for transmitting STIs to the
           community. Prior to this intervention, the investigators did a preliminary study and
           found a high number of sex partners (median: 4, range: 1-25) and high prevalence of
           unprotected sex (90%) and STIs (60%) in this group. Other factors in this group that
           facilitate the transmission of STIs is that 36% continued to engage in unprotected sex
           and half of the boys (49%) and three quarters of the girls (77%) delayed seeking
           treatment for more than a week after experiencing symptoms of STIs. The rate at which
           STIs spread in a population depends upon the average number of new cases of infection
           generated by an infected person (the basic or case reproduction ratio (Ro). This ratio,
           in turn, depends upon the efficiency of transmission, (b), the mean rate of change of
           sexual partners (c), and the average duration of infectiousness (D) as expressed in the
           form: Ro=b*c*D. Given their high number of sex partners and the long duration of
           infectiousness owing to their delay in seeking treatment, they would form an important
           group for spreading STIs to the general population.

        2. The investigators are able to adopt a rigorous study design, that is, a randomized
           controlled trial in a clinical setting to evaluate the efficacy of the intervention, and
           validate self-reported behaviors with laboratory tests for STIs. In contrast, it is less
           feasible to conduct the study in schools presently because of the sensitivity of the
           topic, conservative attitudes of parents and possible biases of self-reported sexual
           behavior in schools. School-based interventions will also exclude school drop outs, who
           were found in this ongoing study, to be significantly, more likely to engage in sexual
           activity.

        3. The investigators have conducted needs assessment of this group and this would help in
           developing interventions specifically for them. For instance, the investigators found
           that both males and females lack the confidence of using condoms correctly. The
           investigators incorporated a session on instilling skills for condom use in our
           intervention.
    

Intervention name(s): Adolescent Behavioral Intervention
Intervention type(s): Behavioral
Intervention description(s): Session 1 focuses on STI/HIV education and self-reflection. Session 2 aims to increase the awareness of STI/HIV preventive strategies by instilling condom use and negotiation skills. Motivational Interviewing is used during the behavioural counselling. Session 3 reviews the goal on safer sex set by the participant and examines the successful strategies on safer sex and identifies triggers for relapse. Success stories are shared to renew their motivation. Session 4 reinforces the progress of the participant by recapitulating the knowledge and motivation explored in previous sessions. The online sessions, by phone/SMS/Whatsapp are conducted 2 months after the second and third sessions to find out if they face any difficulties and to reinforce prevention information covered previously.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Prevention
Keywords: Sexual behavior; condom use; secondary abstinence