Evidence Review: Prevention of Sexually Transmitted Infections, with a Focus on Bacterial Sexually Transmitted Infections Population and Public Health BC Ministry of Health September 2014 This is a review of evidence and best practice that should be seen as a guide to understanding the scientific and community-based research, rather than as a formula for achieving success. This review does not necessarily represent ministry policy, and may include practices that are not currently implemented throughout the public health system in BC. This is to be expected as the purpose of the Core Public Health Functions process—consistent with the quality improvement approach widely adopted in private and public sector organizations across Canada—is to put in place a performance improvement process to move the public health system in BC towards evidence-based best practice. Health authorities will develop public performance improvement plans with feasible performance targets and will develop and implement performance improvement strategies that move them towards best practice in the program component areas identified in the Model Program Paper. These strategies, while informed by the evidence in this review, will be tailored to local context. This Evidence Review should be read in conjunction with the accompanying Model Core Program Paper. Evidence Review accepted by: Population and Public Health, Ministry of Health (March 2014) © BC Ministry of Health, 2014 Edited by: Gina Ogilvie, MD MSc FCFP DrPH Richard Lester, MD, FRCPC Former Medical Director Former Medical Head STI/HIV Control Clinical Prevention Services, BC Centre for Disease Control Clinical Prevention Services, BC Centre for Disease Control Associate Professor, Faculty of Medicine Clinical Assistant Professor University of British Columbia Division of Infectious Diseases, University of British Columbia Mark Gilbert, MD, FRCPC Former Physician Epidemiologist Bobbi Brownrigg, RN, BScN, MBA Leader, Epidemiology and Surveillance Leader Public Health Initiatives and Innovation Online Sexual Health Services Clinical Prevention Services, BC Centre for Disease Control Clinical Prevention Services, BC Centre for Disease Control Clinical Associate Professor Ciro Panessa, NP(F), MSN School of Population and Public Health Former Director Blood Borne Pathogens Faculty of Medicine, University of British Columbia Population and Public Health, BC Ministry of Health Adjunct Professor Darlene Taylor, RN MSc, PhD School of Nursing, University of British Columbia Research Program Manager Clinical Prevention Services, BC Centre for Disease Control Gina McGowan, MSc Director of Blood Borne Pathogens BC Ministry of Health Prepared by: Audrey Campbell, MD MHSc FRCPC Brian E. Ng, MD, MPH, CCFP* Clinical Research Associate, BC Centre for Disease Control Public Health Consultant and Family Physician Communicable Disease Control and Public Health Clinical Instructor, Department of Family Practice Emergency Management University of British Columbia Public Health Physician Consultant Course Director, Doctor, Patient, and Society 420, Course Director, Doctor, Patient, and Society 420 Vancouver-Fraser Medical Program Vancouver-Fraser Medical Program Site Faculty for Research and Evidence-based Medicine Clinical Instructor, Department of Pediatrics Vancouver-Fraser Family Practice Residency Program Faculty of Medicine, University of British Columbia *Denotes Professional Corporation Paul Blasig, RN, BSN Community Health Nurse Nurse Consultant Reviewed by: James Blanchard, MD, MPH, PhD Ameeta Singh, BMBS (UK), MSc, FRCPC Professor, Department of Community Health Sciences Medical Director, AHS-Edmonton STI Clinic Director, Centre for Global Public Health Clinical Professor University of Manitoba Division of Infectious Diseases University of Alberta Colin Q-T Lee, MD, MSc, CCFP (EM), FRCPC Associate Medical Officer of Health Marc Steben, MD, Dess, CCFP, FCFP Simcoe Muskoka District Health Unit, Barrie Ontario Medical Advisor, STI Unit, Institut National de Santé Publique du Québec Core Public Health Functions for BC: Evidence Review Prevention of Sexually Transmitted Infections, with a Focus on Bacterial Sexually Transmitted Infections Table of Contents Executive Summary ............................................................................................................................ i 1.0 Overview/Setting the Context ...................................................................................................1 1.1 The Core Functions Framework ................................................................................................ 1 1.2 Introduction to the Core Public Health Program of Communicable Disease ............................ 2 1.3 Organization of this Report ....................................................................................................... 3 2.0 Methodology ............................................................................................................................4 2.1 Primary Evidence Review .......................................................................................................... 5 2.1.1 Micro-level Interventions ............................................................................................. 6 2.1.2 Meso- and Macro-level Interventions .......................................................................... 7 2.2 Supplemental Evidence Review: Youth ..................................................................................... 7 2.3 Supplemental Evidence Review: MSM ...................................................................................... 8 2.4 Strength of Evidence ................................................................................................................. 9 2.5 Expert Review Panel ................................................................................................................ 11 3.0 Background ............................................................................................................................ 12 3.1 Health Implications.................................................................................................................. 12 3.2 Special Considerations for Youth ............................................................................................ 12 3.3 Special Considerations for MSM ............................................................................................. 13 3.4 Review of Epidemiology of STI in BC ....................................................................................... 13 3.4.1 Chlamydia ................................................................................................................... 14 3.4.2 Gonorrhea .................................................................................................................. 14 3.4.3 Infectious Syphilis ....................................................................................................... 14 3.4.4 Other Data from BC Studies ....................................................................................... 14 4.0 Micro-Level Interventions ....................................................................................................... 16 4.1. STI/HIV Prevention Counselling and Behavioural Interventions ............................................. 16 4.1.1 General Behavioural Interventions ............................................................................ 17 4.1.2 Behavioural Interventions Stressing Ethnic Pride and Skill-building .......................... 19 4.1.3 Youth-focused Behavioural Interventions (Youth Supplemental Review) ................. 20 4.1.4 MSM-focused Behavioural Interventions (MSM Supplemental Review) ................... 20 4.1.5 Cognitive-behavioural Interventions Aimed at Preventing STIs ................................ 22 4.1.6 Brief Behavioural Interventions ................................................................................. 23 4.2 Small Group Sessions............................................................................................................... 25 4.3 Peer Education ........................................................................................................................ 25 4.4 Online Interventions Targeting Youth (Youth Supplemental Review) ..................................... 26 4.5 Screening and Treating Chlamydia to Prevent Pelvic Inflammatory Disease ......................... 28 4.5.1 Youth-focused Home-based STI Screening (Youth Supplemental Review) ................ 29 4.5.2 MSM-Focused STI Screening (MSM Supplemental Review) ....................................... 30 4.6 Abstinence and Reduction of Sexual Partners ........................................................................ 32 4.7 Male Condoms ........................................................................................................................ 32 4.8 Female Condoms ..................................................................................................................... 33 4.9 Cervical Diaphragms ................................................................................................................ 33 4.10 Topical Microbicides and Spermicides .................................................................................... 34 4.11 Male Circumcision ................................................................................................................... 34 4.11.1 Male Circumcision for MSM (MSM