The proposed study responds to RFA-DA-08-007, which calls for research to """"""""develop and test integrated drug use and HIV risk behavior prevention interventions in criminal justice settings"""""""". Despite the large and growing number of drug-involved female offenders under community supervision and accumulating evidence of their elevated risk for HIV/STIs, there remains a critical gap in evidence-based HIV prevention interventions for this population. The proposed study is designed to address this critical gap by conducting a randomized controlled trial (RCT) that will rigorously test the efficacy of a multimedia version of 4-session, gender-specific, integrated drug use and HIV/STI prevention intervention (Multimedia WORTH) in increasing condom use and decreasing the incidence of sexually transmitted infections (STIs) among 420 drug-involved female offenders in a large Alternative-to-Incarceration(ATI) Probation Program in New York City, compared to a non-media version of the same intervention (Traditional WORTH) and to a 4-session NIDA standard HIV prevention control condition, which is not gender-specific (NIDA Control). Participants will be assessed with repeated measures at baseline, immediate post test (IPT), 6-month, and at 12-month post-intervention follow-ups. Multimedia interventions have been found to be efficacious in promoting HIV risk reduction and reducing substance use compared to non-multimedia interventions. Furthermore, multimedia interventions hold promise for increasing the fidelity of implementation and the speed, scale and quality of dissemination. The Traditional WORTH intervention was developed by this study's investigative team as a group-based, integrated drug use and HIV prevention intervention for low income, urban female offenders which addresses intimate partner violence (IPV) and other gender specific risk factors for HIV. WORTH has been tested in two different RCTs and found to be efficacious in increasing condom use among drug-involved female inmates and among women in drug treatment. Multimedia WORTH contains the same content as Traditional WORTH, but employs multimedia interactive tools and culturally tailored animation and video enhancements that are designed to enhance the delivery of the intervention by maximizing individual learning opportunities and feedback, while at the same time optimizing the group format to build positive peer norms and social support for HIV risk reduction. This rigorous RCT will advance the science and extend the boundaries of multimedia HIV prevention research while aiming to close a critical gap in HIV prevention efforts in the criminal justice system.
Significance The proposed study addresses a significant public health threat of HIV and other STIs among drug-involved female offenders under community supervision The proposed randomized controlled trial will rigorously test the efficacy of a gender specific multimedia HIV prevention intervention on increasing condom use and reducing incidence of STIs. This innovative multimedia approach that may enhance the impact and delivery of standardized group-based HIV prevention interventions and further holds promise for increasing capacity, quality, and speed in disseminating evidenced-based HIV prevention interventions in overburdened criminal justice settings.
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