Interventions to Prevent Sexually Transmitted Infections, Including HIV, Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature

Abstract

Sexually transmitted infections (STIs), including HIV, are prevalent among adolescents and can have lasting adverse health consequences. The objective of this review is to identify high-quality interventions and evaluations to decrease STI transmission and related risky behaviors among young people in low- and middle-income countries. PubMed, Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Databases were searched without language limitations for articles published through November 2015. Gray literature was searched by hand. Reference tracing was utilized, as well as the unpacking of systematic reviews. Retained articles were those that were evaluated as having high-quality interventions and evaluations using standardized scoring. Twenty-one high-quality interventions and evaluations were abstracted. Three reported declines in STI diagnoses, three reported declines in STI symptoms, six showed declines in risky sexual behavior, seven reported increases in abstinence, 11 found increases in condom use, and five reported increases in health care utilization. There is a wide range of rigorously evaluated high-quality interventions included in this review that can inform researchers, donors, and policy makers about where to make strategic investments to decrease the spread of STIs, including HIV. With the recent advent of biomarkers, researchers can use a gold standard measure to assess intervention impact. The diversity of interventions can allow decision makers to tailor interventions to the context, age range, and gender of the target population.

Keywords: Abstinence; Adolescent; Condom use; HIV; Low-income countries; Middle-income countries; STIs; Sexually transmitted infections; Sexual risk behavior; Young adult; Youth.