Date Published: June 24, 2008
Publisher: Public Library of Science
Author(s): Lee Warner, Jeffrey D Klausner, Cornelis A Rietmeijer, C. Kevin Malotte, Lydia O’Donnell, Andrew D Margolis, Gregory L Greenwood, Doug Richardson, Shelley Vrungos, Carl R O’Donnell, Craig B Borkowf, George Davey Smith
Abstract: BackgroundSexually transmitted disease (STD) prevention remains a public health priority. Simple, practical interventions to reduce STD incidence that can be easily and inexpensively administered in high-volume clinical settings are needed. We evaluated whether a brief video, which contained STD prevention messages targeted to all patients in the waiting room, reduced acquisition of new infections after that clinic visit.Methods and FindingsIn a controlled trial among patients attending three publicly funded STD clinics (one in each of three US cities) from December 2003 to August 2005, all patients (n = 38,635) were systematically assigned to either a theory-based 23-min video depicting couples overcoming barriers to safer sexual behaviors, or the standard waiting room environment. Condition assignment alternated every 4 wk and was determined by which condition (intervention or control) was in place in the clinic waiting room during the patient’s first visit within the study period. An intent-to-treat analysis was used to compare STD incidence between intervention and control patients. The primary endpoint was time to diagnosis of incident laboratory-confirmed infections (gonorrhea, chlamydia, trichomoniasis, syphilis, and HIV), as identified through review of medical records and county STD surveillance registries. During 14.8 mo (average) of follow-up, 2,042 patients (5.3%) were diagnosed with incident STD (4.9%, intervention condition; 5.7%, control condition). In survival analysis, patients assigned to the intervention condition had significantly fewer STDs compared with the control condition (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.84 to 0.99).ConclusionsShowing a brief video in STD clinic waiting rooms reduced new infections nearly 10% overall in three clinics. This simple, low-intensity intervention may be appropriate for adoption by clinics that serve similar patient populations.Trial registration:http://www.ClinicalTrials.gov (#NCT00137670).
Partial Text: Approximately 19 million incident cases of sexually transmitted infections occur in the United States annually . While several effective interventions have been developed for patients at risk for infection [2–6], these interventions typically focus on individual or group risk reduction, involve multiple sessions, and require significant resources to implement. Simple, practical interventions that can reduce sexually transmitted disease (STD) incidence in high-volume clinical settings are needed to complement existing prevention activities.
Data on 38,635 patients who visited participating STD clinics from December 2003 to August 2005 were included in analyses (Figure 1). Most patients were male (70%), members of minority races/ethnicities (54%), aged 25 y or older (69%), heterosexual (78%), and attended clinics in San Francisco (51%) or Denver (41%). Overall, 5,990 patients (16%) were diagnosed with one or more laboratory-confirmed infections (primarily gonorrhea or chlamydia) at the index visit. The numbers and characteristics of patients assigned to each condition were well-matched and approximately equal (Table 1).
Compared with the standard waiting room experience, the Safe in the City video intervention significantly reduced the incidence of laboratory-confirmed infections among patients attending these STD clinics. Given the large number of patients visiting public STD clinics annually, the approximately 10% effect size observed in this study could result in clinically meaningful reductions in new infections if applied to clinics with similar populations where the intervention is similarly effective. Clinics may be willing to adopt simple, low-cost, low-intensity waiting room interventions, which can be administered with minimal staff time as part of a routine clinic visit, in addition to more intensive but effective interventions that require additional patient or staff time to implement.