Evaluation of HIS-UK
Research type
Research Study
Full title
Evaluating the Home-based Intervention Strategy (HIS-UK) to reduce new chlamydia infection among young men aged 16-25 years by promoting correct and consistent condom use: What is the cost effectiveness of two different delivery models (face-to-face and digital delivery)?
IRAS ID
255684
Contact name
Cynthia Graham
Contact email
Sponsor organisation
University of Southampton
Duration of Study in the UK
5 years, 0 months, 1 days
Research summary
Research Summary:
The reduction of sexually transmitted infections (STIs) is a priority area. Condoms remain the main protection against STIs when used correctly and consistently, yet there are many condom use barriers which reduce their usage, such as decreased sexual pleasure, fit-and-feel problems, lubrication issues and erection difficulties.The UK Home-Based Intervention Strategy (HIS-UK) is a behaviour change condom promotion intervention for young men designed to enhance enjoyment of condom-protected intercourse, improve attitudes towards condoms, improve the correct and consistent use of condoms, and thereby reduce the risk of STIs. The programme gives out a kit containing different types of condoms and lubricants and asks men to experiment with the contents at home by themselves following condom use education and training. HIS-UK has two delivery models; digital delivery using an interactive website (eHIS), and face-to-face delivered by a trained health professional (proHIS).
To compare the effectiveness of HIS-UK delivered by proHIS and eHIS-UK to improve condom use experiences and reduce STI incidence, as compared to usual care, we will recruit 2231 men aged 16-25 years who are at STI risk through the non-use of condoms during sex with casual and/or new partners. Men will be recruited from sexual health(SH)/Genitourinary (GUM) services, GP/Health Centres, and linked community SH/GUM outreach facilities within each site across England and Wales. Participants will be assigned at random to receive either proHIS, eHIS or usual condom care and will be followed up for 12 months during which they will be asked at regular intervals about their sexual behaviour, condom use experiences and to take Chlamydia tests. We will also collect health economic data to compare the resource use and cost-effectiveness of delivering HIS-UK by the two models to that of usual condom distribution care.This project is funded by the National Institute for Health Research, Public Health Research Programme.
Summary of Results:
THE RESEARCH QUESTION Sexually transmitted infections (STIs) are a major public health concern in the UK. Condoms are the most effective method at reducing the risk of STIs so long as they are used consistently and correctly. There are, however, many barriers to using condoms, including reduced sensations and problems with comfort and fit.The HIS-UK programme was designed to help men experience better sex when using condoms. We wanted to find out if young men who received the HIS-UK education, advice, training and supplies, changed their attitudes to condoms and used them more. We also wanted to see if they were less likely to test positive for chlamydia, the most common STI among young people.
WHAT HAPPENED
We invited men living in England to join the trial; 2387 were screened to see if they could take part, 725 were randomly allocated into one of three groups, and 580 were involved in the final trial. All volunteers were aged between 16 and 25 years and had recent experience of a sexual encounter which put them at risk of catching an STI.The volunteers were distributed into the following groups:
- The proHIS group contained 123 men who received the HIS-UK education and advice delivered face-to-face by a trained professional
- The eHIS group contained 229 men who received HIS-UK education and advice delivered digitally by an interactive website
- The control group contained 228 men who received information about using condoms supplied by the NHS.Men who received HIS-UK education and advice were also given a kit containing a range of different condoms and lubricants to experiment with whilst at home and alone. After trying out the condoms and lubricants they were asked to complete online rating and feedback forms and were able to order more supplies of the products they liked the best.
All volunteers were offered screening for chlamydia at the start of the trial, and again at six months. They were also asked about their condom attitudes and sexual behaviour every month.
WHAT WE FOUND OUT
Our trial was impacted by COVID-19 and had to be halted for a period of time. Consequently we were not able to recruit as many men to the trial as we had hoped or follow them up for as long as we intended.However, we did find that, in comparison to men in the control group, men who received the HIS-UK programme were significantly:
(1) more positive about condoms and identified fewer barriers to using them;
(2) more likely to agree that condoms can be enjoyable to use and can help you have better sex;
(3) more confident in their ability to use condoms correctly;
(4) more likely to use condoms and additional lubricant with sexual partners; and
(5) less likely to report errors and problems when using condoms.
After six months follow-up, men who had received the HIS-UK programme were also 55% less likely to test positive for chlamydia. However, it was not possible to fully assess the programme’s ability to reduce chlamydia infection rates because of the reduced number of volunteers in the final trial.
The results of this study indicate that HIS-UK can improve how men think and feel about condoms, and how they use them. This shows that the programme can be effective in encouraging changes in sexual behaviours and reducing the risk of sexually transmitted infections.
REC name
South Central - Oxford B Research Ethics Committee
REC reference
19/SC/0486
Date of REC Opinion
4 Nov 2019
REC opinion
Further Information Favourable Opinion