Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 2106 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599-7435, USA.
Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
AIDS Behav. 2021 Nov;25(11):3669-3686. doi: 10.1007/s10461-021-03242-8. Epub 2021 Mar 27.
Young adolescents in Sub-Saharan Africa (SSA) are at high risk of involvement in sexual risk behaviors; and curable sexually transmitted infections (STI), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and unintended pregnancies remain persistently high in this population. Evidence based strategies are urgently needed to improve these outcomes. The aim of this systematic review was to synthesize the evidence from randomized controlled trials (RCT) to determine whether school-based interventions promote safe sex behaviors, reduce sexual risk behaviors and risk of curable STIs, HSV-2, HIV and unintended pregnancies among young adolescents aged 9-19 years in SSA. Electronic databases were searched for published studies and manual searches were conducted through reviewing of references of cited literature in the English language up to December 2019. Two independent reviewers screened and abstracted the data. We identified 428 articles and data from nine RCTs (N = 14,426 secondary school students) that fulfilled the selection criteria were analysed. Two studies measured pregnancy as an outcome and showed significant declines in unintended pregnancies. Of the five studies that measured HIV/AIDS related-knowledge, condom-use outcomes (normative beliefs, knowledge, and self-efficacy) and attitudes to HIV testing, four showed significant improvements. Of the six studies that measured sexual debut, four reported moderate but non-significant declines and in two studies sexual debut information was either incomplete or unreliable. One study measured curable STIs and found no significant declines; whilst the second study that measured HSV-2 and HIV, no significant declines were observed. This review highlights the need to undertake well-designed research studies to provide evidence on the impact of interventions on curable STIs, HSV-2 and HIV, critical to improving the health of young adolescents.
撒哈拉以南非洲（SSA）的青少年处于参与性风险行为的高风险中；在该人群中，可治愈的性传播感染（STI）、单纯疱疹病毒 2 型（HSV-2）、人类免疫缺陷病毒（HIV）和意外怀孕仍然居高不下。迫切需要基于证据的策略来改善这些结果。本系统评价的目的是综合随机对照试验（RCT）的证据，以确定基于学校的干预措施是否能促进安全性行为，减少性风险行为以及撒哈拉以南非洲 9-19 岁青少年的可治愈性 STI、HSV-2、HIV 和意外怀孕的风险。我们在英语数据库中搜索了已发表的研究，并通过手动搜索参考文献，对截至 2019 年 12 月的引用文献进行了综述。两名独立的评审员筛选并提取了数据。我们确定了 428 篇文章和 9 项 RCT 的数据（N=14426 名中学生），这些研究符合选择标准并进行了分析。有两项研究将怀孕作为结果进行测量，结果显示意外怀孕率显著下降。在五项测量与艾滋病毒/艾滋病相关的知识、避孕套使用结果（规范信念、知识和自我效能）和对艾滋病毒检测的态度的研究中，有四项显示出显著改善。在六项测量首次性行为的研究中，有四项报告了适度但无统计学意义的下降，在两项研究中，首次性行为的信息要么不完整，要么不可靠。一项研究测量了可治愈的 STI，发现没有显著下降；而第二项研究测量 HSV-2 和 HIV，也没有观察到显著下降。本综述强调需要进行精心设计的研究，以提供关于干预措施对可治愈的 STI、HSV-2 和 HIV 的影响的证据，这对于改善青少年的健康至关重要。
