Behavioral Counseling Can Effectively Reduce Sexually Transmitted Infections

U.S. Preventive Services Task Force recommends that primary care clinicians offer high-intensity programs to all sexually active teens and high-risk adults

(Portland, Ore.) – With 19 million new cases a year in the United States and an annual price tag of $15 billion, sexually transmitted infections (STIs) present a major public health threat. Young people are disproportionately hit; about half the cases occur among teens and younger adults, aged 12-24 years old. This isn’t news. Twelve years ago, the U.S. Preventive Services Task Force (USPSTF) recommended that teens and high-risk adults receive counseling to reduce the incidence of sexually transmitted infections.

What is news is that today USPSTF is updating those 1996 recommendations based on TCHR research.

Last year, the federal agency assigned the Oregon Evidence-based Practice Center (EPC) to conduct a systematic review of behavioral counseling programs on STIs in primary care settings. The goal was to find out if and how well these programs worked. TCHR’s Dr. Evelyn Whitlock is the Principal Investigator for the Oregon EPC contract for the USPSTF. In a year-long investigation, her team of scientists led by Dr. Jennifer Lin, reviewed more than 3,000 abstracts and studies of behavioral counseling programs for STIs. They studied 15 of the most rigorous, primary care-relevant trials. Findings, reported to the USPSTF, are published in the October 7th edition of the Annals of Internal Medicine.

TCHR found that these programs can work, and the best can work wonders. Our investigators discovered that high-intensity behavioral counseling programs (multiple sessions lasting from 3 to 9 hours) effectively reduce the number of new STIs in high-risk adults and sexually active teenagers. Results were startling in the largest trial cited, which included 5,758 people. Compared to patients receiving only brief counseling (10 minutes or less), people who received more intensive behavioral counseling with HIV testing had about 20% fewer new STIs at one year. Results in teens aged 14–20 were even more dramatic. Those who received two 20-minute sessions of behavioral counseling with HIV testing had about 40% fewer STIs at one year. A 40% reduction in the very group that bears half the burden can make a substantial impact on this vulnerable population.

Unfortunately, effective programs are hard to come by. They are resource-intensive and require trained staff. Furthermore, how often and how well primary care physicians take sexual history and assess risk varies widely. Nonetheless, we have taken the first step in the process, gathering objective information to mobilize policy change to protect America’s public health. We need a starting line in order to begin the race, and now we have it.

Not only do these findings have vast policy implications, but they also demonstrate the breadth and reach of the expertise we have here at TCHR. Consider today’s CEO Update to be chapter two in a three-part series on TCHR-led systematic reviews on topics of immense importance to public health. Last week, the subject was behavioral programs to help obese kids control weight. Within the next few days, you’ll hear about the findings of TCHR’s systematic review of colorectal screening programs—yet another example of our work advancing knowledge to improve health.

 

Kaiser Permanente’s Center for Health Research, founded in 1964, is a non-profit research institution whose mission is advancing knowledge to improve health. It has research sites in Portland OR; Honolulu, HI; and Atlanta, GA.  www.kpchr.org