Despite the rapid decline in teen pregnancy rates in recent years, teen pregnancies and STIs remain a significant concern, especially for minority youth. As a result, numerous sexual health programs have been introduced, with some success. In Austin, Texas, an implementation of “Making Proud Choices” entitled Peer-to-Peer (P2P) was introduced in 2015 and serves between 750 and 800 students of largely Hispanic origin annually.


In this study, we assessed whether P2P was cost-beneficial. We used a Bernoulli model to estimate averted cases of pregnancies, key STIs and their sequelae: HIV, chlamydia, gonorrhea, genital herpes, human papillomavirus and pelvic inflammatory disease based on changes in sexual activity and contraceptive use. We estimated costs by multiplying these averted outcomes by their costs. Interpretation of the results was hampered by low power, a pre-post methodology with serial cross-section design. We therefore also substituted results from two widely-cited meta-analyses.


Results from P2P when using data from the program evaluation were adverse, with increases in all of our negative outcomes. Therefore, P2P was not cost-beneficial. Using results from our meta-analyses yielded positive outcomes, but the results still were not cost-beneficial. Sensitivity analyses were performed based on a Monte Carlo simulation. They reveal that when the most advantageous values of certain parameters were included, P2P would be cost-beneficial in some instances.

Discussion or Conclusion

Our results were largely driven by the fact that condom use did not increase in the P2P program, nor did sexual activity decline. However, our Monte Carlo simulation revealed that in some instances, P2P was cost beneficial. However, this study, along with others revealing mixed outcomes, shows that the intervention needs modification to be successful.

Key Take Away Points

  • APH P2P program is not favorable, ranging from -0.28 to 0.98 depending on the set of program effects used
  • Sensitivity analyses, based on parameters for outcomes from the literature, revealed B/C ratios ranging from 0.56 to 1.16 (cost-beneficial)