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Female condom introduction and sexually transmitted infection prevalence: results of a community intervention trial in Kenya

Feldblum, Paul J.a; Kuyoh, Maureen A.b; Bwayo, Job J.c; Omari, Mohamedb,*; Wong, Emelita L.a; Tweedy, Kathryn G.a; Welsh, Michael J.b

Epidemiology & Social

Objective: To measure the impact on sexually transmitted infection (STI) prevalence of a female condom introduction and risk-reduction program at Kenyan agricultural sites.

Design: We conducted a cluster-randomized trial to determine whether a replicable, community-level intervention would reduce STI prevalence.

Methods: Six matched pairs of tea, coffee and flower plantations were identified. The six intervention sites received an information/motivation program with free distribution of female and male condoms, and six control sites received only male condoms and related information. Participants were tested for cervical gonorrhea and chlamydia by ligase chain reaction on urine specimens, and vaginal trichomoniasis by culture, at baseline, 6 and 12 months.

Results: Participants at intervention (n = 969) and control sites (n = 960) were similar; baseline STI prevalence was 23.9%. Consistent male condom use was more than 20% at 12 months. Consistent female condom use was reported by 11 and 7% of intervention site women at 6 and 12 months. Unadjusted STI prevalence was 16.5 and 17.4% at 6 months, and 18.3 and 18.5% at 12 months, at the intervention and control sites, respectively. Logistic regression models confirmed the null effect of the female condom intervention.

Conclusions: Female condom introduction did not enhance STI prevention at these sites. It is unclear which aspects of the intervention – STI education, condom promotion, case management – were associated with decreased STI prevalence from baseline to follow-up.

From aFamily Health International, Research Triangle Park, North Carolina, USA, bFamily Health International, Nairobi, and cDepartment of Medical Microbiology, University of Nairobi, Nairobi, Kenya. Note: At the time of the study, M.O. was with the University of Nairobi Department of Medical Microbiology.

Correspondence to Paul Feldblum, PhD, Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, USA. Tel: +1 919 544 7040; fax: +1 919 544 7261; e-mail: pfeldblum@fhi.org

Received: 5 January 2001;

revised: 23 February 2001; accepted: 8 March 2001.

Sponsorship: Partial support for this work was provided by Family Health International (FHI) with funds from the US Agency for International Development (USAID). The views expressed in this article, however, do not necessarily reflect those of USAID. Most of the female condoms were donated by the Department for International Development (DfID) of the United Kingdom. STI treatment kits were supplied by the Kenya Ministry of Health.

© 2001 Lippincott Williams & Wilkins, Inc.