Sub-Saharan Africa has the world’s highest rates of sexual health challenges. Yet, sexual health curricula for health students are rare. To advance research on the effects of such a curricula, we conducted the first randomized controlled trial of a sexual health curriculum for health students. “Training for Health Professionals” was a randomized, controlled, single-blind, trial conducted in Tanzania. In 2021, 412 nursing, midwifery, and medical students were stratified by discipline, completed baseline assessments, then randomized to receive a four-day comprehensive curriculum (n = 206) or to a waitlist control (n = 206). The curriculum covered sexual health across the lifespan, male and female sexual dysfunctions, key populations (LGBT, sex workers), sexual violence, clinical skills building, ethics, policy writing, and cultural considerations. Primary outcomes were assessments of sexual health knowledge, attitudes, and clinical skills at baseline, post-intervention, and three-month follow-up. Clinical skills were evaluated through videotaped standardized patient interviews assessed by expert raters blind to arm of study or baseline/follow-up interview. Attrition was minimal (< 1%); final sample size was 408. Compared to control, intervention participants had statistically significant, moderate to large, increases in sexual health knowledge (<InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10508_2025_3207_Article_IEq1.gif" Format="GIF" Height="17" Rendition="HTML" Resolution="72" Type="Linedraw" Width="221" /> </InlineMediaObject> <EquationSource Format="TEX">$\beta =3.49, SE=0.24, p<0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>β</mi> <mo>=</mo> <mn>3.49</mn> <mo>,</mo> <mi>S</mi> <mi>E</mi> <mo>=</mo> <mn>0.24</mn> <mo>,</mo> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation>), confidence in addressing patients’ concerns (<InlineEquation ID="IEq2"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10508_2025_3207_Article_IEq2.gif" Format="GIF" Height="17" Rendition="HTML" Resolution="72" Type="Linedraw" Width="229" /> </InlineMediaObject> <EquationSource Format="TEX">$\beta =29.34, SE=3.26, p<0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>β</mi> <mo>=</mo> <mn>29.34</mn> <mo>,</mo> <mi>S</mi> <mi>E</mi> <mo>=</mo> <mn>3.26</mn> <mo>,</mo> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation>), ability to discuss sexual health with patients (<InlineEquation ID="IEq3"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10508_2025_3207_Article_IEq3.gif" Format="GIF" Height="17" Rendition="HTML" Resolution="72" Type="Linedraw" Width="229" /> </InlineMediaObject> <EquationSource Format="TEX">$\beta =22.00, SE=1.99, p<0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>β</mi> <mo>=</mo> <mn>22.00</mn> <mo>,</mo> <mi>S</mi> <mi>E</mi> <mo>=</mo> <mn>1.99</mn> <mo>,</mo> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation>), and improved clinical skills (<InlineEquation ID="IEq4"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10508_2025_3207_Article_IEq4.gif" Format="GIF" Height="17" Rendition="HTML" Resolution="72" Type="Linedraw" Width="224" /> </InlineMediaObject> <EquationSource Format="TEX">$\beta =8.04, SE=0.60,\,p<0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>β</mi> <mo>=</mo> <mn>8.04</mn> <mo>,</mo> <mi>S</mi> <mi>E</mi> <mo>=</mo> <mn>0.60</mn> <mo>,</mo> <mspace width="0.166667em" /> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation> for interpersonal communication; <InlineEquation ID="IEq5"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10508_2025_3207_Article_IEq5.gif" Format="GIF" Height="17" Rendition="HTML" Resolution="72" Type="Linedraw" Width="221" /> </InlineMediaObject> <EquationSource Format="TEX">$\beta =2.50, SE=0.28, p<0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>β</mi> <mo>=</mo> <mn>2.50</mn> <mo>,</mo> <mi>S</mi> <mi>E</mi> <mo>=</mo> <mn>0.28</mn> <mo>,</mo> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation> for medical history taking). Most participants (76.6%) evaluated the curriculum as culturally appropriate for Africa. No adverse effects were observed. This study provides “gold standard” evidence that training in sexual health is culturally acceptable, needed, and effective for nursing, midwifery, and medical students. Such training may be particularly important in sub-Saharan Africa and low- and middle-income countries given substantial sexual health challenges.

Effects of an Afrocentric Sexual Health Education Curriculum for Medical, Nursing, and Midwifery Students in Tanzania: A Single-Blinded Randomized Controlled Phase 3 Trial

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2025年7月1日

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B. R. Simon Rosser,
Dickson Ally Mkoka,
Maria Trent,
Nidhi Kohli,
Lucy R. Mgopa,
Corissa T. Rohloff,
Ever Mkonyi,
Michael W. Ross,
Stella Emmanuel Mushy,
Inari Mohammed,
Agnes F. Massae,
Ziwei Zhang,
Dorkasi L. Mwakawanga,
Gift Gadiel Lukumay

摘要

Sub-Saharan Africa has the world’s highest rates of sexual health challenges. Yet, sexual health curricula for health students are rare. To advance research on the effects of such a curricula, we conducted the first randomized controlled trial of a sexual health curriculum for health students. “Training for Health Professionals” was a randomized, controlled, single-blind, trial conducted in Tanzania. In 2021, 412 nursing, midwifery, and medical students were stratified by discipline, completed baseline assessments, then randomized to receive a four-day comprehensive curriculum (n = 206) or to a waitlist control (n = 206). The curriculum covered sexual health across the lifespan, male and female sexual dysfunctions, key populations (LGBT, sex workers), sexual violence, clinical skills building, ethics, policy writing, and cultural considerations. Primary outcomes were assessments of sexual health knowledge, attitudes, and clinical skills at baseline, post-intervention, and three-month follow-up. Clinical skills were evaluated through videotaped standardized patient interviews assessed by expert raters blind to arm of study or baseline/follow-up interview. Attrition was minimal (< 1%); final sample size was 408. Compared to control, intervention participants had statistically significant, moderate to large, increases in sexual health knowledge ( $\beta =3.49, SE=0.24, p<0.001$ $β = 3.49, S E = 0.24, p < 0.001$ ), confidence in addressing patients’ concerns ( $\beta =29.34, SE=3.26, p<0.001$ $β = 29.34, S E = 3.26, p < 0.001$ ), ability to discuss sexual health with patients ( $\beta =22.00, SE=1.99, p<0.001$ $β = 22.00, S E = 1.99, p < 0.001$ ), and improved clinical skills ( $\beta =8.04, SE=0.60,\,p<0.001$ $β = 8.04, S E = 0.60, p < 0.001$ for interpersonal communication; $\beta =2.50, SE=0.28, p<0.001$ $β = 2.50, S E = 0.28, p < 0.001$ for medical history taking). Most participants (76.6%) evaluated the curriculum as culturally appropriate for Africa. No adverse effects were observed. This study provides “gold standard” evidence that training in sexual health is culturally acceptable, needed, and effective for nursing, midwifery, and medical students. Such training may be particularly important in sub-Saharan Africa and low- and middle-income countries given substantial sexual health challenges.