对青年友好的性健康服务和同伴支持,以改善南非青少年和年轻人的性健康和生殖健康结果:一项因子随机对照试验的结果

IF 1.7 4区 医学 Q3 INFECTIOUS DISEASES
Sexually transmitted diseases Pub Date : 2025-11-01 Epub Date: 2025-07-21 DOI:10.1097/OLQ.0000000000002203
Jana Jarolimova, Jacob Busang, Natsayi Chimbindi, Nonhlanhla Okesola, Theresa Smit, Guy Harling, Nuala McGrath, Andrew Copas, Janet Seeley, Kathy Baisley, Maryam Shahmanesh
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引用次数: 0

摘要

背景:南非青少年和青壮年的性传播感染和意外怀孕负担很高。我们评估了同伴支持和/或扩大的性健康和生殖健康(SRH)服务对南非夸祖鲁-纳塔尔省农村性传播感染、避孕和怀孕的影响。方法:我们分析了2020年3月至2022年8月在16-29岁人群中进行的一项2x2因子随机对照试验的次要结果,比较了:1)增强标准护理(SoC):获得青年友好型移动艾滋病毒预防(AYFS);2)性生殖健康:自我收集性传播感染检测并转介到AYFS,扩大性生殖健康服务;3)同伴支持:同伴导航员促进AYFS出席;4) SRH +同伴支持。在12个月时,所有参与者都进行了性传播感染检测;女性参与者自我报告避孕使用和怀孕情况。结果:在1743名试验参与者中(51%为女性),927名(53%)有12个月的STI结果;209例(22.5%)检测呈阳性:衣原体163例(17.6%),淋病54例(5.8%),滴虫44例(4.8%)。暴露于同伴支持(经性别、年龄、地点调整的aOR: 0.77, 95%CI 0.56-1.06)或SRH (aOR 0.74, 0.56-1.06)的性传播感染患病率略低,与SoC相比,暴露于两者的性传播感染患病率均降低(aOR 0.59, 0.38-0.94)。在SRH组中,64/469(13.6%)在12个月时发生了新的STI,同伴支持没有差异(p = 0.97)。在女性中,336/634(53.0%)报告使用避孕措施,47/667(7.1%)报告怀孕,各组差异不大。结论:同伴支持和扩展性生殖健康的性传播感染检测对性传播感染、避孕或怀孕的影响都不大。需要联合或更密集的干预措施,例如,重复筛查、加强伴侣通知和更深入地了解结构驱动因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Youth-Friendly Sexual Health Services and Peer Support for Improved Sexual and Reproductive Health Outcomes Among Adolescents and Young Adults in South Africa: Results of a Factorial Randomized Controlled Trial.

Background: Adolescents and young adults in South Africa have high burdens of sexually transmitted infections (STIs) and unintended pregnancy. We evaluated the impact of peer support and/or expanded sexual and reproductive health (SRH) services on STIs, contraception, and pregnancy in rural KwaZulu-Natal, South Africa.

Methods: We analyzed secondary outcomes from a 2 × 2 factorial randomized controlled trial conducted from March 2020 to August 2022 among 16- to 29-year-olds, comparing (1) enhanced standard of care (SoC), access to mobile youth-friendly HIV prevention (AYFS); (2) SRH, self-collected STI testing and referral to AYFS with expanded SRH services; (3) peer support, peer navigator facilitation of AYFS attendance; (4) SRH + peer support. At 12 months, all participants were offered STI testing; female participants self-reported contraceptive use and pregnancy.

Results: Among 1743 trial participants (51% female), 927 (53%) had 12-month STI results; 209 (22.5%) tested positive: 163 (17.6%) chlamydia, 54 (5.8%) gonorrhea, and 44 (4.8%) trichomoniasis. The prevalence of STI was somewhat lower among those exposed to peer support (adjusted odds ratio [aOR] adjusted for sex, age, location, 0.77; 95% confidence interval, 0.56-1.06) or SRH (aOR, 0.74; 0.56-1.06) and, compared with SoC, was reduced in those exposed to both (aOR, 0.59; 0.38-0.94). In SRH arms, 64 of 469 (13.6%) had a new STI at 12 months, with no difference by peer support ( P = 0.97). Among females, 336 of 634 (53.0%) reported using contraception and 47 of 667 (7.1%) reported pregnancy, with little difference by study arm.

Conclusions: Peer support and STI testing with expanded SRH each had no more than small effects on STIs, contraception, or pregnancy. Combined or more intensive interventions, for example, repeat screening, enhanced partner notification, and deeper understanding of structural drivers, are needed.

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来源期刊
Sexually transmitted diseases
Sexually transmitted diseases 医学-传染病学
CiteScore
4.00
自引率
16.10%
发文量
289
审稿时长
3-8 weeks
期刊介绍: ​Sexually Transmitted Diseases, the official journal of the American Sexually Transmitted Diseases Association​, publishes peer-reviewed, original articles on clinical, laboratory, immunologic, epidemiologic, behavioral, public health, and historical topics pertaining to sexually transmitted diseases and related fields. Reports from the CDC and NIH provide up-to-the-minute information. A highly respected editorial board is composed of prominent scientists who are leaders in this rapidly changing field. Included in each issue are studies and developments from around the world.
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