The search for effective HIV interventions tailored to African American female adolescents remains a public health priority. A subgroup at considerable risk of HIV are African American adolescent females being treated for STDs. Thus, there is an urgent need for efficacious, cost-effective interventions that can be used in public health STD clinics to reduce female adolescents' HIV risk. The proposed study uses a Phase III randomized, controlled trial design, to evaluate the efficacy of an HIV intervention plus standard-of-care counseling compared with standard-of-care counseling only. A random sample of 960 females, 15-19 years of age, will be recruited at the Fulton County Department of Health and Wellness (FCDHW) STD Program following receipt of STD treatment and standard-of-care counseling. Eligible teens, at baseline, will complete an audio computer-assisted interview (ACASI) and provide a urine specimen that will be analyzed using nucleic acid amplification assays to detect STDs (chlamydia, gonorrhea, and trichomoniasis). The interview, derived from Social Cognitive Theory and the Theory of Gender and Power, will measure HIV risk behaviors, sociodemographics, culturally- and gender-relevant factors associated with risk and preventive practices, and other theoretically-relevant mediators of HIV risk behaviors. After 40 adolescents complete baseline assessments, they will be re- contacted and asked to return to the FCDHW (we expect 80 percent will return). Returning teens will be randomized to either an HIV intervention or a control condition. Adolescents in the control condition will view a video about the importance of nutrition. Those assigned to the HIV intervention will participate in a culturally-relevant and gender-tailored intervention implemented by FCDHW health educators, assisted by peer educators, over three consecutive Saturdays. The HIV intervention will emphasize enhancing: (a) gender and ethnic pride, (b) HIV prevention knowledge, (c) self-efficacy for condom use, negotiation skills, and refusal skills, (d) norms supportive of abstaining from sex and using condoms if engaging in sexual behavior, and (e) building healthy relationships. All adolescents will return at 4-, 8- and 12-months post-intervention to complete an ACASI interview, similar to the baseline interview, and provide a urine specimen for STD assay. Immediately following their completion of the 4- and 8-month follow-up assessments, adolescents in the HIV intervention will also participate in booster sessions designed to reinforce prevention messages and prevent relapse to risk behaviors. An intent-to-treat analysis, controlling for baseline assessments, will determine the efficacy of the HIV intervention plus the standard-of-care counseling, relative to standard-of-care STD counseling only, in reducing HIV sexual risk behaviors and incident STDs over a 12-month follow-up period. Secondary analyses will evaluate the impact of the intervention condition, relative to the control condition, on hypothesized mediators of HIV-preventive behavior, and, evaluate the cost-effectiveness of the intervention condition, relative to the control condition, with respect to increasing random use and averting incident STDs.
Showing the most recent 10 out of 33 publications
