Jarolimova Jana, Busang Jacob, Chimbindi Natsayi, Okesola Nonhlanhla, Smit Theresa, Harling Guy, McGrath Nuala, Copas Andrew, Seeley Janet, Baisley Kathy, Shahmanesh Maryam
Massachusetts General Hospital, Boston, USA.
Africa Health Research Institute, Durban, South Africa.
Sex Transm Dis. 2025 Jul 21. doi: 10.1097/OLQ.0000000000002203.
Adolescents and young adults in South Africa have high burdens of 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.
We analyzed secondary outcomes from a 2x2 factorial randomized controlled trial conducted March 2020-August 2022 among 16-29-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.
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, 44 (4.8%) trichomoniasis. STI prevalence was somewhat lower among those exposed to peer-support (aOR adjusted for sex, age, location: 0.77, 95%CI 0.56-1.06) or SRH (aOR 0.74, 0.56-1.06) and, compared to SoC, was reduced in those exposed to both (aOR 0.59, 0.38-0.94). In SRH arms, 64/469 (13.6%) had a new STI at 12 months, with no difference by peer-support (p = 0.97). Among females, 336/634 (53.0%) reported using contraception and 47/667 (7.1%) pregnancy, with little difference by study arm.
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, e.g., repeat screening, enhanced partner notification, and deeper understanding of structural drivers, are needed.
南非的青少年和青年面临着性传播感染（STIs）和意外怀孕的沉重负担。我们评估了同伴支持和/或扩大性与生殖健康（SRH）服务对南非夸祖鲁 - 纳塔尔农村地区性传播感染、避孕和怀孕情况的影响。
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2×2析因随机对照试验的次要结果，比较了：1）强化标准护理（SoC）：提供适合青年的移动HIV预防服务（AYFS）；2）SRH：自我采集性传播感染检测并转介至提供扩大SRH服务的AYFS；3）同伴支持：同伴导航员协助参加AYFS；4）SRH + 同伴支持。在12个月时，所有参与者都接受了性传播感染检测；女性参与者自我报告了避孕措施的使用和怀孕情况。
在1743名试验参与者中（51%为女性），927人（53%）有12个月的性传播感染检测结果；209人（22.5%）检测呈阳性：163人（17.6%）感染衣原体，54人（5.8%）感染淋病，44人（4.8%）感染滴虫病。在接受同伴支持（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）干预的人群中，性传播感染患病率略低，与标准护理组相比，同时接受这两种干预的人群患病率降低（aOR 0.59，0.38 - 0.94）。在SRH组中，64/469（13.6%）在12个月时有新的性传播感染，同伴支持对此无差异（p = 0.97）。在女性中، 336/634（53.0%）报告使用了避孕措施，47/667（7.1%）怀孕，各研究组之间差异不大。
同伴支持和扩大SRH服务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。需要联合或更强化的干预措施，例如重复筛查、加强性伴通知以及更深入了解结构性驱动因素。
