Young women are at high risk of contracting sexually transmitted infections (STIs), including types of human papillomavirus (HPV) that can cause cervical cancer. High rates of STIs among young people highlight a need for effective strategies to prevent the spread of infections. Although behavioural approaches (e.g. using condoms consistently) could protect against STIs and cervical cancer, there is a lack of evidence on which strategies would be most effective in practice. This systematic literature review was conducted to identify which types of behavioural strategy have been tested and to assess their effectiveness.
Eight electronic bibliographic databases were searched up to the end of 2009. To be considered relevant, studies had to use a randomised controlled trial (RCTs) design; include young women up to the age of 25 years; report one or more behavioural interventions that aimed to prevent STIs or cervical cancer; and record outcomes which were either behavioural (e.g. condom use) or biological (incidence of STIs or cervical cancer).
Searches identified 5271 bibliographic records. Screening the records independently by two review authors identified 23 relevant randomised controlled trials (RCTs). The trials were mostly conducted in the USA (21 trials) and in health-care (e.g. family planning) clinics (14 trials), with only four in educational settings. Trial participants had mixed socio-economic and demographic characteristics and most were sexually experienced. The interventions mostly provided information about STIs and taught safer sex skills (e.g. communication with partners), occasionally supplemented with provision of resources (e.g. free sexual health services). Interventions varied considerably in duration, contact time, provider, behavioural aims and outcomes. A variety of STIs were addressed including HIV and chlamydia, but not explicitly HPV.
The most common behavioural outcome (measured in 19 trials) was condom use for vaginal intercourse. Sexual partners, sexual abstinence and STIs were reported in four, two and 12 trials respectively. In terms of statistically significant effects, some interventions improved condom-related behaviour and reduced the number of sexual partners, but none affected the frequency of sexual episodes. Effects of interventions on STIs were limited. None of the interventions appeared to be harmful. The methods used in the trials were not always well described making it difficult to tell whether their results may have been biased. In conclusion, although some behavioural interventions improve condom-related behaviour, trials have been predominantly in USA healthcare settings, did not specifically address HPV and were too different to enable a most effective type of intervention to be identified.