Efficacy of behavioral interventions to increase engagement in sexual health services among LatinX youth in the United States: A meta-analysis for post-pandemic implications

Abstract

Introduction: LatinX youth in the U.S. are disproportionately affected by HIV and STIs, commonly attributed to a lack of diagnostic testing and regular physician consultations to address sexual health. These disparities have been exacerbated by the COVID-19 pandemic. This meta-analysis seeks to assess the efficacy of behavioral interventions among LatinX youth in the U.S. that aim to increase engagement in sexual health services (i.e., STI/HIV testing, physician consultations).

Content: Following PRISMA guidelines, seven electronic databases were searched. We systematically extracted data with a coding form, and effect sizes were obtained from each study on HIV/STI testing outcomes and physician consultation. Moderator analyses were run for demographic and intervention characteristics.

Summary and outlook: Of nine included studies, the interventions created a small-to-moderate effect on increased engagement of sexual health services (d ₊=0.204, 95 % CI=0.079, 0.329). Moderator analyses showed that interventions including the following characteristics were most efficacious at facilitating care services: community-based or online setting, access to diagnostic testing, social media/remote components, parental involvement, and longer session duration. This meta-analysis provides informative results regarding behavioral interventions that have proven efficacious in facilitating engagement in sexual health services among LatinX youth. Most prominently, interventions that are remote or through social media, community-based, and incorporated parents had large positive effects. These findings prove useful for the ongoing COVID-19 pandemic situation and provide guidance for targeting LatinX youth to engage them in sexual health services as primary and secondary STI and HIV prevention.

Keywords: HIV prevention; Latino youth; STI prevention; meta-analysis; sexual healthcare.

Figure 1:

PRISMA flowchart for screening and inclusion of studies included in this subset meta-analysis.

Figure 2:

Distribution of the frequency of intervention components across the 10 interventions.

Figure 3:

Risk of bias assessment.

Figure 4:

Forest plot displaying the overall effect size and individual effect sizes for related sexual health care service outcomes among 10 interventions. Each horizontal line represents the 95 % confidence interval of the overall effect size for each corresponding study, outcome, and subgroup (where applicable). The black boxes represent the point estimate of the study; the larger the box, the larger the sample size of that study. The null line (dotted line) through the forest plot separates whether the effect favored the control or intervention groups (e.g., black boxes that fall to the right of the null line represent an effect that favors the intervention group). Horizontal lines that do not cross the null line represent a significant effect of the corresponding intervention. The diamond represents the point estimate and confidence intervals when you combine and average all of the individual studies together. The horizontal points of the diamond represent the limits of the 95 % confidence intervals; thus, since the diamond does not touch or cross the null line, it can be interpreted as a statistically significant overall effect of the studies.