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BACKGROUND: Infections with Chlamydia trachomatis and Neisseria gonorrhoeae are the most frequently reported sexually transmitted infections (STIs) in the United States. In suburban Cook County, IL, adolescents under age 20 comprise a leading age group affected by STIs, with over 30% of all cases reported in 2012. Previous studies have shown that repeat STIs amplify the risk of adverse reproductive health outcomes and are predictive of future infections. We examined the effect of individualized Risk Reduction Counseling (RRC) on the frequency of repeat STIs among high-risk adolescents in suburban Cook County (SCC).
METHODS: High-risk adolescents, defined as SCC residents between the ages of 13-19 years with two or more occurrences of STIs, at least 21 days apart, between February, 2012 and October, 2014, were selected. Based on their response to the offer of RRC intervention, subjects were assigned to one of two groups: the intervention group (RRC), that received individualized RRC intervention by a Disease Intervention Specialist (DIS) via phone or in-person, and the non-intervention group (No RRC) that either refused or could not be reached. Both groups were monitored for subsequent new reports of STIs for twelve months beginning on the date of the provision of the RRC, or for the non-intervention group, the date of the last reported infection. Survival analysis and adjusted hazard ratios were used to compare recurrent infections among the two groups.
RESULTS: Of the 215 cases meeting the high risk adolescent criteria, 84% were females and 67% were African Americans. The mean age of cases was 17 years. Overall, 27% of cases had a repeat infection during follow-up. Compared to the non-intervention group (n= 108), those in the intervention group (n= 107) were 77% less likely to have a repeat infection after receiving RRC (HR=0.23; 95% CI (0.10, 0.51); p=0.0003). Age, race, ethnicity, gender, or district of residence was not associated with an increased risk of repeat infection.
CONCLUSIONS: Our findings suggest that an individualized single-session RRC intervention delivered via phone or in-person had a positive effect in reducing repeat STIs in high-risk SCC teenagers. As this was a new intervention, it is not certain whether this effect will be maintained with future cases. We will continue to monitor the impact of this intervention on STIs in high risk adolescents and consider modifications and improvements as necessary to assure positive project outcomes.