英国伦敦卫生与热带医学院Caroline Free团队研究了短信行为干预（safetxt）对16-24岁人群性传播再感染的有效性。2022年9月28日，《英国医学杂志》发表了这一成果。

为了量化社区内发送的一系列短信（safetxt）对16-24岁人群一年内衣原体和淋病再感染发病率的影响，研究组在英国的92家性健康诊所进行了一项平行组随机对照试验。招募过去两周内患有衣原体、淋病或非特异性尿道炎的16-24岁人群，均拥有手机。

3123名参与safetxt干预的参与者收到了一系列改善性行为的短信：第1-3天每天四条，第4-28天每天一条或两条，第2个月每周两条或三条，第3-12个月每月2-5条。3125名对照组参与者在一年内每月收到一条短信，要求更改邮政或电子邮件地址。主要结局是通过核酸扩增试验评估一年内衣原体或淋病再感染的累积发病率。安全结局是自我报告的道路交通事件和伴侣暴力。所有分析均为意向性治疗。

在2016年4月1日至2018年11月23日，研究组对20476人中的6248人进行了资格评估。4675/6248（74.8%）的主要结局数据可用。一年后，safetxt组衣原体或淋病再感染的累积发病率为22.2%（693/3123），而对照组为20.3%（633/3125）（比值比为1.13）。伤害所需人数为64（95%置信区间受益所需人数334至∞ 伤害所需人数24）。两组之间发生道路交通事故和伴侣暴力的风险相似。

研究结果表明，safetxt干预并不能减少16-24岁人群一年内衣原体和淋病的再感染。safetxt组发生了更多再感染。亟需对卫生传播干预措施进行严格评估。

附：英文原文

Title: Effectiveness of a behavioural intervention delivered by text messages (safetxt) on sexually transmitted reinfections in people aged 16-24 years: randomised controlled trial

Author: Caroline Free, Melissa J Palmer, Ona L McCarthy, Lauren Jerome, Sima Berendes, Megan Knight, James R Carpenter, Tim P Morris, Zahra Jamal, Farandeep Dhaliwal, Rebecca S French, Ford Colin Ian Hickson, Anasztazia Gubijev, Kaye Wellings, Paula Baraitser, Ian Roberts, Julia V Bailey, Tim Clayton, Karen Devries, Phil Edwards, Graham Hart, Susan Michie, Louis Macgregor, Katy M E Turner, Kimberley Potter

Issue&Volume: 2022/09/28

Abstract:

Objective To quantify the effects of a series of text messages (safetxt) delivered in the community on incidence of chlamydia and gonorrhoea reinfection at one year in people aged 16-24 years.

Design Parallel group randomised controlled trial.

Setting 92 sexual health clinics in the United Kingdom.

Participants People aged 16-24 years with a diagnosis of, or treatment for, chlamydia, gonorrhoea, or non-specific urethritis in the past two weeks who owned a mobile phone.

Interventions 3123 participants assigned to the safetxt intervention received a series of text messages to improve sex behaviours: four texts daily for days 1-3, one or two daily for days 4-28, two or three weekly for month 2, and 2-5 monthly for months 3-12. 3125 control participants received a monthly text message for one year asking for any change to postal or email address. It was hypothesised that safetxt would reduce the risk of chlamydia and gonorrhoea reinfection at oneyear by improving three key safer sex behaviours: partner notification at one month, condom use, and sexually transmitted infection testing before unprotected sex with a new partner. Care providers and outcome assessors were blind to allocation.

Main outcome measures The primary outcome was the cumulative incidence of chlamydia or gonorrhoea reinfection at one year, assessed by nucleic acid amplification tests. Safety outcomes were self-reported road traffic incidents and partner violence. All analyses were by intention to treat.

Results 6248 of 20476 people assessed for eligibility between 1 April 2016 and 23 November 2018 were randomised. Primary outcome data were available for 4675/6248 (74.8%). At one year, the cumulative incidence of chlamydia or gonorrhoea reinfection was 22.2% (693/3123) in the safetxt arm versus 20.3% (633/3125) in the control arm (odds ratio 1.13, 95% confidence interval 0.98 to 1.31). The number needed to harm was 64 (95% confidence interval number needed to benefit 334 to ∞ to number needed to harm 24) The risk of road traffic incidents and partner violence was similar between the groups.

Conclusions The safetxt intervention did not reduce chlamydia and gonorrhoea reinfections at one year in people aged 16-24 years. More reinfections occurred in the safetxt group. The results highlight the need for rigorous evaluation of health communication interventions.

DOI: 10.1136/bmj-2022-070351

Source: https://www.bmj.com/content/378/bmj-2022-070351