The effectiveness and cost-effectiveness of behavioural interventions for the prevention of sexually transmitted infections in young people aged 13-19: a systematic review and economic evaluation
The effectiveness and cost-effectiveness of behavioural interventions for the prevention of sexually transmitted infections in young people aged 13-19: a systematic review and economic evaluation
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DOI：
10.3310/hta14070
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发表时间：
2010-02-01
影响因子：
3.6
通讯作者：
Price, A.
中科院分区：
文献类型：
--
作者：
Shepherd, J.;Kavanagh, J.;Price, A.
目的：评估以学校为基础的技能培养行为干预措施的有效性和成本效益，以鼓励年轻人采取和保持更安全的性行为，并防止他们获得性传播感染。数据来源：检索1985年至2008年3月的电子书目数据库（如MEDLINE、MEDLINE In-Process & Other Non-Indexed citation、EMBASE、CINAHL、PsycINFO、CCRCT、NHS EED和DARE）。筛选了系统综述和相关论文的参考书目，并联系了专家以确定其他已发表和未发表的参考文献。评价方法：进行了系统的效果评价和成本效益经济评价。生成了符合纳入标准的研究的描述性地图，并开发了关键词，并系统地应用于这些研究，以确定与政策相关的研究子集，用于系统评价。提取了包括性行为在内的变量的结果数据。开发了一个经济模型来比较行为干预的成本和后果。建立了描述STI感染概率的伯努利统计模型。结果：干预组和比较组在性行为结局的改变方面没有显著差异，但在知识和自我效能的一些测量方面存在显著差异。这篇综述中包括的研究在许多年轻人变得性活跃的时候进行了相对较短的随访评估。因此，随着时间的推移，随着性活动在年轻人的生活中变得越来越常规，有利的行为改变可能已经发生，并且变得更具成本效益。干预提供者的质量影响年轻人是否认为干预是可接受的和参与的；热情和相当的专业知识对于有效的班级管理和技能培养活动的开展很重要，支持性的学校文化也很有帮助。认识到青年人在性健康方面的个人需要是另一个重要因素。由于缺乏有关社会经济地位、性别和种族的相关数据，无法就干预措施对性健康不平等的影响得出结论。经济评估的结果被认为是说明性的，主要是因为干预对行为结果的影响存在不确定性。结果对干预效果参数值、性传播感染概率和性伴侣数量的变化最为敏感。根据我们系统回顾中相关随机对照试验估计的资源，教师主导和同伴主导的行为干预的成本分别为每个学生4.30英镑和15英镑。教师主导的干预比同伴主导的干预更具成本效益，因为对培训的需求较少。教师主导和同伴主导干预的成本效益增量分别为每质量调整生命年增加20223英镑和80782英镑。对个体参数的分析表明，未来的研究经费应该集中在评估以学校为基础的干预措施对避孕套使用的干预效果。结论：以学校为基础的预防青少年性传播感染的行为干预可以提高知识水平，提高自我效能感，但对性冒险行为或感染率没有显著影响。未来的调查应包括长期随访，以评估在多大程度上采取并保持更安全的性行为直到成年，并需要前瞻性队列研究来研究描述性传播感染在伴侣之间传播的参数。供资应侧重于影响行为的干预措施的有效性。
Objectives: To assess the effectiveness and cost-effectiveness of schools-based skills building behavioural interventions to encourage young people to adopt and maintain safer sexual behaviour and to prevent them from acquiring sexually transmitted infections (STIs).Data sources: Electronic bibliographic databases (e.g. MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, CINAHL, PsycINFO, CCRCT, NHS EED and DARE) were searched for the period 1985 to March 2008. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify additional published and unpublished references.Review methods: A systematic review of effectiveness and economic evaluation of cost-effectiveness were carried out. A descriptive map of studies that met inclusion criteria was produced, and keywords were developed and systematically applied to these studies to identify a policy-relevant subset of studies for the systematic review. Outcome data for variables including sexual behavioural were extracted. An economic model was developed to compare the costs and consequences of the behavioural interventions. A Bernoulli statistical model was constructed to describe the probability of STI infection.Results: There were few significant differences between the interventions and comparators in terms of changes in sexual behaviour outcomes, although there were some significant differences for knowledge and some measures of self-efficacy. The studies included in this review conducted relatively short follow-up assessments at a time when many young people were becoming sexually active. It is therefore possible that favourable behaviour change may have occurred, and become more cost-effective, with time, as sexual activity becomes more routine in young people's lives. The quality of the intervention provider influenced whether or not young people found the interventions to be acceptable and engaging; enthusiasm and considerable expertise were important for effective class management and delivery of skills-building activities, and a supportive school culture was also helpful. Recognition of young people's individual needs in relation to sexual health was another important factor. No conclusions could be drawn on the impact of the interventions on sexual health inequalities due to a lack of relevant data on socioeconomic status, gender and ethnicity. The results of the economic evaluation were considered to be illustrative, mainly due to the uncertainty of the effect of intervention on behavioural outcomes. The results were most sensitive to changes in parameter values for the intervention effect, the transmission probability of STIs and the number of sexual partners. The costs of teacher-led and peer-led behavioural interventions, based on the resources estimated from the relevant randomised controlled trials in our systematic review, were 4.30 pound and 15 pound per pupil, respectively. Teacher-led interventions were more cost-effective than peer-led interventions due to the less frequent need for training. The incremental cost-effectiveness of the teacher-led and peer-led interventions was 20,223 pound and 80,782 pound per quality-adjusted life-year gained, respectively. An analysis of individual parameters revealed that future research funding should focus on assessing the intervention effect for condom use from a school-based intervention.Conclusions: School-based behavioural interventions for the prevention of STIs in young people can bring about improvements in knowledge and increased self-efficacy, but the interventions did not significantly influence sexual risk-taking behaviour or infection rates. Future investigation should include long-term follow-up to assess the extent to which safer sexual behaviour is adopted and maintained into adulthood, and prospective cohort studies are needed to look at the parameters that describe the transmission of STIs between partners. Funding should focus on the effectiveness of the interventions on influencing behaviour.