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

Objective: To measure the impact on sexually transmitted infection (STI) pr evalence of a female condom introduction and risk-reduction program at Keny an agricultural sites. Design: We conducted a cluster-randomized trial to determine whether a repl icable, community-level intervention would reduce STI prevalence. Methods: Six matched pairs of tea, coffee and flower plantations were ident ified. The six intervention sites received an information/motivation progra m with free distribution of female and male condoms, and six control sites received only male condoms and related information. Participants were teste d for cervical gonorrhea and chlamydia by ligase chain reaction on urine sp ecimens, and vaginal trichomoniasis by culture, at baseline, 6 and 12 month s. Results: Participants at intervention (n = 969) and control sites (n = 960) were similar; baseline STI prevalence was 23.9%. Consistent male condom us e 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 t hese sites. It is unclear which aspects of the intervention - STI education , condom promotion, case management - were associated with decreased STI pr evalence from baseline to follow-up. (C) 2001 Lippincott Williams & Wilkins .