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. 2008 Jan 23;2008(1):CD007006.
doi: 10.1002/14651858.CD007006.

Abstinence-plus programs for HIV infection prevention in high-income countries

K Underhill, P Montgomery, D Operario

Abstinence-plus programs for HIV infection prevention in high-income countries

K Underhill et al. Cochrane Database Syst Rev. .

Abstract

Background: Abstinence-plus interventions promote sexual abstinence as the best means of preventing acquisition of HIV, but also encourage safer-sex strategies (eg condom use) for sexually active participants.

Objectives: To assess the effects of abstinence-plus programs for HIV prevention in high-income countries.

Search strategy: We searched 30 electronic databases (eg CENTRAL, PubMed, EMBASE, AIDSLINE, PsycINFO) ending February 2007. Cross-referencing, hand-searching, and contacting experts yielded additional citations.

Selection criteria: We included randomized and quasi-randomized controlled trials evaluating abstinence-plus interventions in high-income countries (as defined by the World Bank). Interventions were any efforts that encouraged sexual abstinence as the best means of HIV prevention, but also promoted safer sex. Results were self-reported biological outcomes, behavioral outcomes, and HIV knowledge.

Data collection and analysis: Three reviewers independently appraised 20070 citations and 325 full-text papers for inclusion and methodological quality; 39 evaluations were included. Due to heterogeneity and data unavailability, we presented the results of individual studies instead of a meta-analysis.

Main results: Studies enrolled 37724 North American youth; participants were ethnically diverse. Programs took place in schools (10), community facilities (24), both schools and community facilities (2), healthcare facilities (2), and family homes (1). Median final follow-up occurred 12 months after baseline. Results showed no evidence that abstinence-plus programs can affect self-reported sexually transmitted infection (STI) incidence, and limited evidence that programs can reduce self-reported pregnancy incidence. Results for behavioral outcomes were promising; 23 of 39 evaluations found a significantly protective intervention effect for at least one behavioral outcome. Consistently favorable program effects were found for HIV knowledge.No adverse effects were observed. Several evaluations found that one version of an abstinence-plus program was more effective than another, suggesting that more research into intervention mechanisms is warranted. Methodological strengths included large samples and statistical controls for baseline values. Weaknesses included under-utilization of relevant outcomes, self-report bias, and analyses neglecting attrition and clustered randomization.

Authors' conclusions: Many abstinence-plus programs appear to reduce short-term and long-term HIV risk behavior among youth in high-income countries. Evidence for program effects on biological measures is limited. Evaluations consistently show no adverse program effects for any outcomes, including the incidence and frequency of sexual activity. Trials comparing abstinence-only, abstinence-plus, and safer-sex interventions are needed.

PubMed Disclaimer

Conflict of interest statement

None

Figures

1
1
QUOROM Chart.
1.1
1.1. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 1 STD diagnosis by doctor or nurse ‐ 3m.
1.2
1.2. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 2 STD diagnosis by doctor or nurse ‐ 9m.
1.3
1.3. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 3 Pregnancy ‐ 3m.
1.4
1.4. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 4 Pregnancy ‐ 9m.
1.5
1.5. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 5 Vaginal Intercourse in past 3m ‐ 3m.
1.6
1.6. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 6 Vaginal Intercourse in past 3m ‐ 9m.
1.7
1.7. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 7 Vaginal, Oral, or Anal Intercourse in past 3m ‐ 3m.
1.8
1.8. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 8 Vaginal, Oral, or Anal Intercourse in past 3m ‐ 9m.
1.9
1.9. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 9 Condom use at last vaginal intercourse ‐ 3m.
1.10
1.10. Analysis
Comparison 1 Boekeloo 1999: A+ vs. Usual Care, Outcome 10 Condom use at last vaginal intercourse ‐ 9m.
2.1
2.1. Analysis
Comparison 2 Dancy 2006: A+ Delivered by Mothers vs. A+ Delivered by Health Experts vs. Attention Delivered by Mothers, Outcome 1 Ever had sex ‐ 5m.
2.2
2.2. Analysis
Comparison 2 Dancy 2006: A+ Delivered by Mothers vs. A+ Delivered by Health Experts vs. Attention Delivered by Mothers, Outcome 2 Ever had sex ‐ 5m CLUSTER ADJUSTED.
2.3
2.3. Analysis
Comparison 2 Dancy 2006: A+ Delivered by Mothers vs. A+ Delivered by Health Experts vs. Attention Delivered by Mothers, Outcome 3 Knowledge ‐ 5m.
2.4
2.4. Analysis
Comparison 2 Dancy 2006: A+ Delivered by Mothers vs. A+ Delivered by Health Experts vs. Attention Delivered by Mothers, Outcome 4 Knowledge 5m CLUSTER ADJUSTED.
3.1
3.1. Analysis
Comparison 3 DiIorio 2006: A+ vs. Information, Outcome 1 Condom use at last sex ‐ 24m.
3.2
3.2. Analysis
Comparison 3 DiIorio 2006: A+ vs. Information, Outcome 2 Condom use at last sex ‐ 24m CLUSTER ADJUSTED.
3.3
3.3. Analysis
Comparison 3 DiIorio 2006: A+ vs. Information, Outcome 3 Ever had sex ‐ 4m.
3.4
3.4. Analysis
Comparison 3 DiIorio 2006: A+ vs. Information, Outcome 4 Ever had sex ‐ 4m CLUSTER ADJUSTED.
3.5
3.5. Analysis
Comparison 3 DiIorio 2006: A+ vs. Information, Outcome 5 Ever had sex ‐ 12m.
3.6
3.6. Analysis
Comparison 3 DiIorio 2006: A+ vs. Information, Outcome 6 Ever had sex ‐ 12m CLUSTER ADJUSTED.
3.7
3.7. Analysis
Comparison 3 DiIorio 2006: A+ vs. Information, Outcome 7 Ever had sex ‐ 24m.
3.8
3.8. Analysis
Comparison 3 DiIorio 2006: A+ vs. Information, Outcome 8 Ever had sex ‐ 24m CLUSTER ADJUSTED.
4.1
4.1. Analysis
Comparison 4 Ferguson 1998: A+ with Peer Counseling vs. A+ without Peer Counseling, Outcome 1 Pregnancy ‐ 3m.
4.2
4.2. Analysis
Comparison 4 Ferguson 1998: A+ with Peer Counseling vs. A+ without Peer Counseling, Outcome 2 Recent sex ‐ 3m.
4.3
4.3. Analysis
Comparison 4 Ferguson 1998: A+ with Peer Counseling vs. A+ without Peer Counseling, Outcome 3 Recent sex ‐ 3m CLUSTER ADJUSTED.
4.4
4.4. Analysis
Comparison 4 Ferguson 1998: A+ with Peer Counseling vs. A+ without Peer Counseling, Outcome 4 Sex ever ‐ 3m.
4.5
4.5. Analysis
Comparison 4 Ferguson 1998: A+ with Peer Counseling vs. A+ without Peer Counseling, Outcome 5 Sex ever ‐ 3m CLUSTER ADJUSTED.
5.1
5.1. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 1 Frequency of unprotected intercourse in past 3m (days) ‐ 3m.
5.2
5.2. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 2 Sexual intercourse in past 3m ‐ 3m.
5.3
5.3. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 3 Frequency of intercourse in past 3m (days) ‐ 3m.
5.4
5.4. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 4 Anal intercourse in past 3m ‐ 3m.
5.5
5.5. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 5 Frequency of anal intercourse in past 3m ‐ 3m.
5.6
5.6. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 6 Number of coital partners in past 3m ‐ 3m.
5.7
5.7. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 7 Number of anal sex partners in past 3m ‐ 3m.
5.8
5.8. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 8 Rated frequency of condom use in past 3m ‐ 3m.
5.9
5.9. Analysis
Comparison 5 Jemmott 1992: A+ vs. Attention, Outcome 9 HIV knowledge ‐ 3m.
6.1
6.1. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 1 Unprotected sex in past 3m ‐ 3m.
6.2
6.2. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 2 Unprotected sex in past 3m ‐ 6m.
6.3
6.3. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 3 Unprotected sex in past 3m ‐ 12m.
6.4
6.4. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 4 Unprotected sex in past 3m among sexually experienced ‐ 3m.
6.5
6.5. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 5 Unprotected sex in past 3m among sexually experienced ‐ 6m.
6.6
6.6. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 6 Unprotected sex in past 3m among sexually experienced ‐ 12m.
6.7
6.7. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 7 Unprotected sex in past 3m among sexually inexperienced ‐ 3m.
6.8
6.8. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 8 Unprotected sex in past 3m among sexually inexperienced ‐ 6m.
6.9
6.9. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 9 Unprotected sex in past 3m among sexually inexperienced ‐ 12m.
6.10
6.10. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 10 Frequency of unprotected sex in past 3m ‐ 3m.
6.11
6.11. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 11 Frequency of unprotected sex in past 3m ‐ 6m.
6.12
6.12. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 12 Frequency of unprotected sex in past 3m ‐ 12m.
6.13
6.13. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 13 Frequency of unprotected sex in past 3m among sexually experienced ‐ 3m.
6.14
6.14. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 14 Frequency of unprotected sex in past 3m among sexually experienced ‐ 6m.
6.15
6.15. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 15 Frequency of unprotected sex in past 3m among sexually experienced ‐ 12m.
6.16
6.16. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 16 Frequency of unprotected sex in past 3m among sexually inexperienced ‐ 3m.
6.17
6.17. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 17 Frequency of unprotected sex in past 3m among sexually inexperienced ‐ 6m.
6.18
6.18. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 18 Frequency of unprotected sex in past 3m among sexually inexperienced ‐ 12m.
6.19
6.19. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 19 Sex in past 3m ‐ 3m.
6.20
6.20. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 20 Sex in past 3m ‐ 6m.
6.21
6.21. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 21 Sex in past 3m ‐ 12m.
6.22
6.22. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 22 Sex in past 3m among sexually experienced ‐ 3m.
6.23
6.23. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 23 Sex in past 3m among sexually inexperienced ‐ 3m.
6.24
6.24. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 24 Frequency of intercourse in past 3m ‐ 3m.
6.25
6.25. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 25 Frequency of intercourse in past 3m ‐ 6m.
6.26
6.26. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 26 Frequency of intercourse in past 3m ‐ 12m.
6.27
6.27. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 27 Frequency of intercourse in past 3m among sexually experienced ‐ 6m.
6.28
6.28. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 28 Frequency of intercourse in past 3m among sexually experienced ‐ 12m.
6.29
6.29. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 29 Frequency of intercourse in past 3m among sexually inexperienced ‐ 6m.
6.30
6.30. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 30 Frequency of intercourse in past 3m among sexually inexperienced ‐ 12m.
6.31
6.31. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 31 Consistent condom use in past 3m ‐ 3m.
6.32
6.32. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 32 Consistent condom use in past 3m ‐ 6m.
6.33
6.33. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 33 Consistent condom use in past 3m ‐ 12m.
6.34
6.34. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 34 Frequency of condom use in past 3m ‐ 3m.
6.35
6.35. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 35 Frequency of condom use in past 3m ‐ 6m.
6.36
6.36. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 36 Frequency of condom use in past 3m ‐ 12m.
6.37
6.37. Analysis
Comparison 6 Jemmott 1998: A+ Abstinence‐focused vs. A+ Condom‐focused vs. Attention, Outcome 37 HIV knowledge at immediate post‐intervention ‐ 12m.
7.1
7.1. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 1 Frequency of unprotected intercourse in past 3m (days) ‐ 3m.
7.2
7.2. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 2 Frequency of unprotected intercourse in past 3m (days) ‐ 6m.
7.3
7.3. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 3 Sexual intercourse in past 3m ‐ 3m.
7.4
7.4. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 4 Sexual intercourse in past 3m ‐ 6m.
7.5
7.5. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 5 Anal intercourse in past 3m ‐ 3m.
7.6
7.6. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 6 Anal intercourse in past 3m ‐ 6m.
7.7
7.7. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 7 Frequency of anal intercourse in past 3m ‐ 3m.
7.8
7.8. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 8 Frequency of anal intercourse in past 3m ‐ 6m.
7.9
7.9. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 9 Number of coital partners in past 3m ‐ 3m.
7.10
7.10. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 10 Number of coital partners in past 3m ‐ 6m.
7.11
7.11. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 11 Number of anal intercourse partners in past 3m ‐ 3m.
7.12
7.12. Analysis
Comparison 7 Jemmott 1999: A+ vs. Attention, Outcome 12 Number of anal intercourse partners in past 3m ‐ 6m.
8.1
8.1. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 1 STD diagnosis ‐ 5m.
8.2
8.2. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 2 STD diagnosis ‐ 5m CLUSTER ADJUSTED.
8.3
8.3. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 3 STD diagnosis ‐ 17m.
8.4
8.4. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 4 STD diagnosis ‐ 17m CLUSTER ADJUSTED.
8.5
8.5. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 5 Pregnancy ‐ 5m.
8.6
8.6. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 6 Pregnancy ‐ 5m CLUSTER ADJUSTED.
8.7
8.7. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 7 Pregnancy ‐ 17m.
8.8
8.8. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 8 Pregnancy ‐ 17m CLUSTER ADJUSTED.
8.9
8.9. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 9 Condom use at last sex ‐ 5m.
8.10
8.10. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 10 Condom use at last sex ‐ 5m CLUSTER ADJUSTED.
8.11
8.11. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 11 Condom use at last sex ‐ 17m.
8.12
8.12. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 12 Condom use at last sex ‐ 17m CLUSTER ADJUSTED.
8.13
8.13. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 13 Sexual initiation ‐ 5m.
8.14
8.14. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 14 Sexual initiation ‐ 5m CLUSTER ADJUSTED.
8.15
8.15. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 15 Sexual initiation ‐ 17m.
8.16
8.16. Analysis
Comparison 8 Kirby 1997: A+ vs. Usual Care, Outcome 16 Sexual initiation ‐ 17m CLUSTER ADJUSTED.
9.1
9.1. Analysis
Comparison 9 McBride 2000a: A+ vs. No Treatment, Outcome 1 Intercourse in past month ‐ 8m.
9.2
9.2. Analysis
Comparison 9 McBride 2000a: A+ vs. No Treatment, Outcome 2 Intercourse ever ‐ 8m.
10.1
10.1. Analysis
Comparison 10 McBride 2000b: A+ vs. No Treatment, Outcome 1 Intercourse in past month ‐ 6m.
10.2
10.2. Analysis
Comparison 10 McBride 2000b: A+ vs. No Treatment, Outcome 2 Intercourse ever ‐ 6m.
11.1
11.1. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 1 Recent sex ‐ 24m.
11.2
11.2. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 2 Recent sex ‐ 24m CLUSTER ADJUSTED.
11.3
11.3. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 3 Recent sex ‐ 36m.
11.4
11.4. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 4 Recent sex ‐ 36m CLUSTER ADJUSTED.
11.5
11.5. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 5 Recent sex ‐ 48m.
11.6
11.6. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 6 Recent sex ‐ 48m CLUSTER ADJUSTED.
11.7
11.7. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 7 Consistent condom use ‐ 24m.
11.8
11.8. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 8 Consistent condom use ‐ 24m CLUSTER ADJUSTED.
11.9
11.9. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 9 Consistent condom use ‐ 36m.
11.10
11.10. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 10 Consistent condom use ‐ 36m CLUSTER ADJUSTED.
11.11
11.11. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 11 Consistent condom use ‐ 48m.
11.12
11.12. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 12 Consistent condom use ‐ 48m CLUSTER ADJUSTED.
11.13
11.13. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 13 Ever had sex ‐ 24m.
11.14
11.14. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 14 Ever had sex ‐ 24m CLUSTER ADJUSTED.
11.15
11.15. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 15 Ever had sex ‐ 36m.
11.16
11.16. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 16 Ever had sex ‐ 36m CLUSTER ADJUSTED.
11.17
11.17. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 17 Ever had sex ‐ 48m.
11.18
11.18. Analysis
Comparison 11 Moberg 1998: A+ Intensive vs. A+ Age‐Appropriate vs. Usual Care, Outcome 18 Ever had sex ‐ 48m CLUSTER ADJUSTED.
12.1
12.1. Analysis
Comparison 12 Philliber 2001: A+ vs. Usual Care, Outcome 1 Pregnancy ‐ 36m.
12.2
12.2. Analysis
Comparison 12 Philliber 2001: A+ vs. Usual Care, Outcome 2 Ever had vaginal sex ‐ 36m.
12.3
12.3. Analysis
Comparison 12 Philliber 2001: A+ vs. Usual Care, Outcome 3 Condom use at last sex among sexually experienced ‐ 36m.
13.1
13.1. Analysis
Comparison 13 Sikkema 2005: A+ Workshops and Community Involvement vs. A+ Workshops Only vs. Information, Outcome 1 Condom use among those ever having sex ‐ 9m.
13.2
13.2. Analysis
Comparison 13 Sikkema 2005: A+ Workshops and Community Involvement vs. A+ Workshops Only vs. Information, Outcome 2 Condom use among those ever having sex ‐ 9m CLUSTER ADJUSTED.
13.3
13.3. Analysis
Comparison 13 Sikkema 2005: A+ Workshops and Community Involvement vs. A+ Workshops Only vs. Information, Outcome 3 Condom use among those ever having sex ‐ 18m.
13.4
13.4. Analysis
Comparison 13 Sikkema 2005: A+ Workshops and Community Involvement vs. A+ Workshops Only vs. Information, Outcome 4 Condom use among those ever having sex ‐ 18m CLUSTER ADJUSTED.
13.5
13.5. Analysis
Comparison 13 Sikkema 2005: A+ Workshops and Community Involvement vs. A+ Workshops Only vs. Information, Outcome 5 Ever had sex among baseline virgins ‐ 9m.
13.6
13.6. Analysis
Comparison 13 Sikkema 2005: A+ Workshops and Community Involvement vs. A+ Workshops Only vs. Information, Outcome 6 Ever had sex among baseline virgins ‐ 9m CLUSTER ADJUSTED.
13.7
13.7. Analysis
Comparison 13 Sikkema 2005: A+ Workshops and Community Involvement vs. A+ Workshops Only vs. Information, Outcome 7 Ever had sex among baseline virgins ‐ 18m.
13.8
13.8. Analysis
Comparison 13 Sikkema 2005: A+ Workshops and Community Involvement vs. A+ Workshops Only vs. Information, Outcome 8 Ever had sex among baseline virgins ‐ 18m CLUSTER ADJUSTED.
14.1
14.1. Analysis
Comparison 14 Smith 1994: A+ vs. Information, Outcome 1 Absolute sexual frequency ‐ 6m.
15.1
15.1. Analysis
Comparison 15 St Lawrence 1995b: A+ with Skills Training vs. A+ without Skills Training, Outcome 1 STI treatment in past 2m ‐ 3.5m.
15.2
15.2. Analysis
Comparison 15 St Lawrence 1995b: A+ with Skills Training vs. A+ without Skills Training, Outcome 2 STI treatment in past 2m ‐ 3.5m CLUSTER ADJUSTED.
15.3
15.3. Analysis
Comparison 15 St Lawrence 1995b: A+ with Skills Training vs. A+ without Skills Training, Outcome 3 Casual sex in past 2m ‐ 3.5m.
15.4
15.4. Analysis
Comparison 15 St Lawrence 1995b: A+ with Skills Training vs. A+ without Skills Training, Outcome 4 Casual sex in past 2m ‐ 3.5m CLUSTER ADJUSTED.
15.5
15.5. Analysis
Comparison 15 St Lawrence 1995b: A+ with Skills Training vs. A+ without Skills Training, Outcome 5 Sex with non‐monogamous partner in past 2m ‐ 3.5m.
15.6
15.6. Analysis
Comparison 15 St Lawrence 1995b: A+ with Skills Training vs. A+ without Skills Training, Outcome 6 Sex with non‐monogamous partner in past 2m ‐ 3.5m CLUSTER ADJUSTED.
15.7
15.7. Analysis
Comparison 15 St Lawrence 1995b: A+ with Skills Training vs. A+ without Skills Training, Outcome 7 HIV knowledge ‐ 3.5m.
15.8
15.8. Analysis
Comparison 15 St Lawrence 1995b: A+ with Skills Training vs. A+ without Skills Training, Outcome 8 HIV knowledge ‐ 3.5m CLUSTER ADJUSTED.
16.1
16.1. Analysis
Comparison 16 Stanton 1996: A+ Intensive Delivered in Friendship Groups vs. A+ Non‐enhanced, No Friendship Group Delivery, Outcome 1 Condom use at last sex ‐ 6m.
16.2
16.2. Analysis
Comparison 16 Stanton 1996: A+ Intensive Delivered in Friendship Groups vs. A+ Non‐enhanced, No Friendship Group Delivery, Outcome 2 Condom use at last sex ‐ 6m CLUSTER ADJUSTED.
16.3
16.3. Analysis
Comparison 16 Stanton 1996: A+ Intensive Delivered in Friendship Groups vs. A+ Non‐enhanced, No Friendship Group Delivery, Outcome 3 Condom use at last sex ‐ 12m.
16.4
16.4. Analysis
Comparison 16 Stanton 1996: A+ Intensive Delivered in Friendship Groups vs. A+ Non‐enhanced, No Friendship Group Delivery, Outcome 4 Condom use at last sex ‐ 12m CLUSTER ADJUSTED.
17.1
17.1. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 1 Recent sex ‐ 3m.
17.2
17.2. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 2 Recent sex ‐ 3m CLUSTER ADJUSTED.
17.3
17.3. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 3 Recent sex ‐ 6m.
17.4
17.4. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 4 Recent sex ‐ 6m CLUSTER ADJUSTED.
17.5
17.5. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 5 Recent sex ‐ 9m.
17.6
17.6. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 6 Recent sex ‐ 9m CLUSTER ADJUSTED.
17.7
17.7. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 7 Condom use at last sex among sexually active ‐ 3m.
17.8
17.8. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 8 Condom use at last sex among sexually active ‐ 3m CLUSTER ADJUSTED.
17.9
17.9. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 9 Condom use at last sex among sexually active ‐ 6m.
17.10
17.10. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 10 Condom use at last sex among sexually active ‐ 6m CLUSTER ADJUSTED.
17.11
17.11. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 11 Condom use at last sex among sexually active ‐ 9m.
17.12
17.12. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 12 Condom use at last sex among sexually active ‐ 9m CLUSTER ADJUSTED.
17.13
17.13. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 13 Ever had sex among baseline virgins ‐ 9m.
17.14
17.14. Analysis
Comparison 17 Stanton 2006: A+ Standard and Culturally Adapted (grouped for analysis) vs. Attention, Outcome 14 Ever had sex among baseline virgins ‐ 9m CLUSTER ADJUSTED.
18.1
18.1. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 1 Sex in last 3m ‐ 3m.
18.2
18.2. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 2 Sex in last 3m ‐ 6m.
18.3
18.3. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 3 Sex in last 3m ‐ 12m.
18.4
18.4. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 4 Multiple partners in last 3m ‐ 3m.
18.5
18.5. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 5 Multiple partners in last 3m ‐ 6m.
18.6
18.6. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 6 Multiple partners in last 3m ‐ 12m.
18.7
18.7. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 7 Consistent condom use in last 3m among sexually active at baseline ‐ 3m.
18.8
18.8. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 8 Consistent condom use in last 3m among sexually active at baseline ‐ 6m.
18.9
18.9. Analysis
Comparison 18 Villarruel 2006: A+ vs. Attention, Outcome 9 Consistent condom use in last 3m among sexually active at baseline ‐ 12m.
19.1
19.1. Analysis
Comparison 19 Weeks 1997: A+ with Parent Involvement vs. A+ without Parent Involvement vs. Usual Care, Outcome 1 Recent sex ‐ 12m.
19.2
19.2. Analysis
Comparison 19 Weeks 1997: A+ with Parent Involvement vs. A+ without Parent Involvement vs. Usual Care, Outcome 2 Recent sex ‐12m CLUSTER ADJUSTED.
19.3
19.3. Analysis
Comparison 19 Weeks 1997: A+ with Parent Involvement vs. A+ without Parent Involvement vs. Usual Care, Outcome 3 Recent sex ‐ 24m.
19.4
19.4. Analysis
Comparison 19 Weeks 1997: A+ with Parent Involvement vs. A+ without Parent Involvement vs. Usual Care, Outcome 4 Recent sex ‐ 24m CLUSTER ADJUSTED.
19.5
19.5. Analysis
Comparison 19 Weeks 1997: A+ with Parent Involvement vs. A+ without Parent Involvement vs. Usual Care, Outcome 5 Ever had sex ‐ 24m.
19.6
19.6. Analysis
Comparison 19 Weeks 1997: A+ with Parent Involvement vs. A+ without Parent Involvement vs. Usual Care, Outcome 6 Ever had sex ‐ 24m CLUSTER ADJUSTED.
19.7
19.7. Analysis
Comparison 19 Weeks 1997: A+ with Parent Involvement vs. A+ without Parent Involvement vs. Usual Care, Outcome 7 Condom use at last sex ‐ 24m.
19.8
19.8. Analysis
Comparison 19 Weeks 1997: A+ with Parent Involvement vs. A+ without Parent Involvement vs. Usual Care, Outcome 8 Condom use at last sex ‐ 24m CLUSTER ADJUSTED.
20.1
20.1. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 1 Pregnancy in past 6m ‐ 24m.
20.2
20.2. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 2 Pregnancy in past 6m ‐ 24m CLUSTER ADJUSTED.
20.3
20.3. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 3 Sex in the past 6m ‐ 6m.
20.4
20.4. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 4 Sex in the past 6m ‐ 6m CLUSTER ADJUSTED.
20.5
20.5. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 5 Sex in the past 6m ‐ 12m.
20.6
20.6. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 6 Sex in the past 6m ‐ 12m CLUSTER ADJUSTED.
20.7
20.7. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 7 Sex in the past 6m ‐ 24m.
20.8
20.8. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 8 Sex in the past 6m ‐ 24m CLUSTER ADJUSTED.
20.9
20.9. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 9 Anal sex in past 6m ‐ 24m.
20.10
20.10. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 10 Anal sex in past 6m ‐ 24m CLUSTER ADJUSTED.
20.11
20.11. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 11 Condom use at last sex among participants reporting sex in the past 6m ‐ 6m.
20.12
20.12. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 12 Condom use at last sex among participants reporting sex in the past 6m ‐ 6m CLUSTER ADJUSTED.
20.13
20.13. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 13 Condom use at last sex among participants reporting sex in the past 6m ‐ 12m.
20.14
20.14. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 14 Condom use at last sex among participants reporting sex in the past 6m ‐ 12m CLUSTER ADJUSTED.
20.15
20.15. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 15 Condom use at last sex among participants reporting sex in the past 6m ‐ 24m.
20.16
20.16. Analysis
Comparison 20 Wu 2003: A+ with Parent Program+Boosters vs. A+ with Parents, no Boosters vs. A+ no Parents or Boosters, Outcome 16 Condom use at last sex among participants reporting sex in the past 6m ‐ 24m CLUSTER ADJUSTED.
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References

References to studies included in this review

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References to studies excluded from this review

Boyer 1997 {published data only}
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References to other published versions of this review

Underhill PLoS
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