Home-based intervention strategy to reduce new chlamydia infection among young men: the HIS-UK RCT

Nicole Stone¹, Cynthia Graham², Rowena Bedford¹, Lauren Towler³, Louise Jackson⁴, Stephen Bremner^{5

6}, Nuala McGrath^{7

8

9}, Katherine Brown¹⁰, Katie Newby¹⁰, Amanda Clarke⁵, Leanne Morrison^{3

11}, Tom Nadarzynski¹², Ye To¹³, Nicky Perry¹³, Jake Bayley¹⁴

Affiliations

¹ Centre for Sexual Health Research, University of Southampton, Southampton, UK.
² Kinsey Institute, Indiana University, Bloomington, IN, USA.
³ Department of Psychology, University of Southampton, Southampton, UK.
⁴ Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
⁵ University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
⁶ Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
⁷ CHERISH Programme, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
⁸ Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
⁹ Africa Health Research Institute, KwaZulu-Natal, South Africa.
¹⁰ School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK.
¹¹ Primary Care Research Centre, University of Southampton, Southampton, UK.
¹² School of Social Sciences, University of Westminster, London, UK.
¹³ Brighton and Sussex Clinical Trials Unit, University of Brighton, Brighton, UK.
¹⁴ Newham University Hospital, Barts NHS Trust, London, UK.

PMID: 41143452
DOI: 10.3310/GJNS1528

Randomized Controlled Trial

Home-based intervention strategy to reduce new chlamydia infection among young men: the HIS-UK RCT

Nicole Stone et al. Public Health Res (Southampt). 2025 Oct.

. 2025 Oct;13(8):1-47.

doi: 10.3310/GJNS1528.

Authors

Affiliations

¹ Centre for Sexual Health Research, University of Southampton, Southampton, UK.
² Kinsey Institute, Indiana University, Bloomington, IN, USA.
³ Department of Psychology, University of Southampton, Southampton, UK.
⁴ Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
⁵ University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
⁶ Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
⁷ CHERISH Programme, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
⁸ Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
⁹ Africa Health Research Institute, KwaZulu-Natal, South Africa.
¹⁰ School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK.
¹¹ Primary Care Research Centre, University of Southampton, Southampton, UK.
¹² School of Social Sciences, University of Westminster, London, UK.
¹³ Brighton and Sussex Clinical Trials Unit, University of Brighton, Brighton, UK.
¹⁴ Newham University Hospital, Barts NHS Trust, London, UK.

PMID: 41143452
DOI: 10.3310/GJNS1528

Abstract

Background: Sexually transmitted infections pose a significant public health challenge in the United Kingdom, prompting the Department of Health and Social Care to prioritise sexually transmitted infection rate reduction as a means of addressing sexual health inequalities. Correct and consistent condom use is the most effective method of reducing sexually transmitted infection transmission.

Methods: A randomised controlled trial with three arms (two intervention arms and one control arm) was conducted to evaluate the effectiveness and cost-effectiveness of the home-based intervention strategy United Kingdom intervention in reducing chlamydia test positivity among 16- to 25-year-old men, and individuals with a penis, at risk of sexually transmitted infections. The home-based intervention strategy United Kingdom intervention, delivered either face to face by health promotion professionals or digitally through an interactive website, aimed to enhance condom use experiences and improve correct and consistent condom use. The control group received usual condom distribution care. Chlamydia screening was conducted at baseline and 6 months post randomisation, with follow-up through online questionnaires. Of the 2387 individuals assessed for eligibility, 1233 were eligible, and 725 participants completed all baseline assessments and were randomised (health promotion professionals: 241, interactive website: 243, control: 241). Five hundred and eighty men received the intervention arm as randomised (health promotion professionals: 51.9%, interactive website: 93.8%, control: 94.2%); 51.7% of participants engaged during follow-up, with 21.4% providing baseline and follow-up chlamydia screening results.

Results: Findings showed the home-based intervention strategy United Kingdom to be well received, with participants valuing the condom kit and materials promoting pleasurable condom use. At the primary end point, home-based intervention strategy United Kingdom participants showed a 4.9 percentage point reduction in chlamydia test positivity compared to the control (7.9% vs. 12.8%). The odds of a positive test were 55% lower for home-based intervention strategy United Kingdom participants compared to the control. However, this reduction was not statistically significant due to the lower-than-planned participant recruitment (a consequence of COVID-19) affecting the trial's power. Home-based intervention strategy United Kingdom positively impacted recent condom use along with significant reductions in condom use errors and problems compared to the control. While no marked effect on consistent condom use emerged, attitudinal shifts were highly significant, with sustained positive condom attitudes, reduced perceived barriers and increased confidence in condom use among home-based intervention strategy United Kingdom participants.

Conclusion: The home-based intervention strategy United Kingdom education and training programme, in conjunction with the provision of a broad selection of products, demonstrated a positive impact on attitudes towards condoms and lubricants, increased confidence in correct condom use and reduced errors and problems. Recent condom and lubricant use increased, but consistent condom usage showed no significant improvement. The odds of a positive chlamydia test were lower for home-based intervention strategy United Kingdom participants, though not statistically significant. This study provides valuable insights into the potential of home-based intervention strategy United Kingdom to enhance sexual health practices among at-risk populations. While it is recognised that home-based intervention strategy United Kingdom is more costly than usual condom distribution care, incorporating key elements of the intervention and messaging into existing practice could offer benefits without making implementation unfeasible.

Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 17/54/06.

Keywords: BEHAVIOUR CHANGE; CHLAMYDIA; CONDOMS; DIGITAL TECHNOLOGY; HEALTH PROMOTION; INTERVENTION; MALE; MOTIVATION; PLEASURE; PUBLIC HEALTH; SAFE SEX; SELF-EFFICACY; SEXUAL BEHAVIOUR; SEXUAL HEALTH; SEXUALLY TRANSMITTED INFECTIONS; UNITED KINGDOM.

Plain language summary

Sexually transmitted infections are a major public health concern in the United Kingdom. Condoms are the most effective method at reducing the risk of sexually transmitted infections if they are used consistently and correctly. The HIS-UK programme was designed to help men, and those with a penis, experience better sex when using condoms. We wanted to find out if those who received the HIS-UK information and advice were more positive about condoms, used condoms more and were less likely to test positive for chlamydia. We invited men living in England to join the trial; 2387 were screened to see if they could take part, and 580 took part in the final trial. All volunteers were aged 16–25 years and had recent experience of a sexual encounter, which put them at risk of catching a sexually transmitted infection. After 6 months, those who received the HIS-UK programme were: more positive about condoms and identified fewer barriers to using them more likely to agree that condoms can be enjoyable to use and can help you have better sex more confident in their ability to use condoms correctly more likely to use condoms and additional lubricant with sexual partners less likely to report errors and problems when using condoms. Men who received HIS-UK were also less likely to test positive for chlamydia. However, it was not possible to fully assess the programme’s ability to reduce infection rates because of the reduced number of volunteers in the final trial (a result of COVID-19). The program’s impact on condom attitudes, increased usage and lower chlamydia rates highlights its relevance in promoting safer sex. We will share these findings with National Health Service health practitioners and commissioners with the hope that aspects of the programme are integrated into sexual health services provided to young people.

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References

1. UNAIDS. UNFPA, WHO and UNAIDS: Position Statement on Condoms and the Prevention of HIV, Other Sexually Transmitted Infections and Unintended Pregnancy. 2015. URL: www.unaids.org/en/resources/presscentre/featurestories/2015/july/2015070... (accessed 14 December 2023).
1. Gov.UK. Campaigns to Protect Young People from STIs by Using Condoms. 2017. URL: www.gov.uk/government/news/campaign-to-protect-young-people-from-stis-by... www.publichealth.hscni.net/news/choose-protect-yourself-always-use-condom (accessed 14 December 2023).
1. Hatherall B, Ingham R, Stone N, McEachran J. How, not just if, condoms are used: the timing of condom application and removal during vaginal sex among young people in England. Sex Transm Infect 2007;83:68–70. https://doi.org/10.1136/sti.2006.021410
1. Sanders SA, Yarber WL, Kaufman EL, Crosby RA, Graham CA, Milhausen RR. Condom use errors and problems: a global view. Sex Health 2012;9:81–95.
1. Graham CA. Condom use in the context of sex research: a commentary. Sex Health 2012;9:103–8.

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Home-based intervention strategy to reduce new chlamydia infection among young men: the HIS-UK RCT

Affiliations

Home-based intervention strategy to reduce new chlamydia infection among young men: the HIS-UK RCT

Authors

Affiliations

Abstract

Plain language summary

References

Publication types

MeSH terms

LinkOut - more resources

Medical