African-American female adolescent population at high risk for HIV infection. Recent findings that culturally and gender are a suggest propriate HIV interventions can significantly enhance condom use among this vulnerable population. However, demonstrating short-term havior change, decay of intervention effects is usually observable within one-year post-intervention. Thus, the development and aluation of innovative strategies designed to enhance the long-term maintenance of HIV-preventive sexual behaviors remains a public alth priority. The proposed study is an exciting opportunity to harness the experience and multidisciplinary expertise of our research Learn to design a randomized controlled, supplementary treatment trial, to evaluate the efficacy and cost-effectiveness of an innovative Mephone-delivered HIV prevention maintenance intervention in sustaining condom protected sexual intercourse over an 18-month follow-up period. A sample of 700 African-American female adolescents, 14-18 years of age, will be recruited at Planned Parenthood, Atlanta. Subsequent to assessing their eligibility and completing consent, adolescents will be re-contacted and invited to return to Planned Parenthood to complete a baseline assessment. At baseline, adolescents will complete ACASI interview, derived from Social Cognitive theory and the Theory of Gender and Power, that assesses sociodemographic characteristics, HIV risk behaviors and key mediators associated with HIV preventive behaviors. Subsequently, adolescents will be randomized to either the experimental condition or the comparison condition. Adolescents in the experimental condition receive the """"""""primary"""""""" treatment, the multi-session, group-delivered SiHLE HIV intervention, that has demonstrated efficacy in enhancing condom protected sexual intercourse and key mediators of HIV prevention over an 18-month follow-up period, and the supplemental intervention, an individualized telephone-delivered HIV Prevention Maintenance Intervention (SiHLE + HIVPMI). Adolescents randomized to this condition receive nine bimonthly individualized telephonc contacts designed to reinforce topics covered in the SiHLE HIV intervention, but are individualized to address each adolescent's personal attitudinal, relational, skills and environmental barriers to maintaining safer sex practices. Adolescents in the comparison condition receive the primary treatment, the SiHLE HIV intervention without the HIV prevention maintenance intervention. However, adolescents in this condition receive a structurally equivalent individualized telephone-delivered nutrition education intervention (SiHLE + NED that is designed to constitute a time- and dose-equivalent attention control comparison condition. Adolescents randomized to the comparisor condition receive nine bimonthly individualized telephone contacts on nutrition education. Adolescents in both conditions complete similm ACASI assessments at baseline, 6-, 12-, and 18-month follow-up. An intent-to-treat analysis, using generalized estimating equations, will assess the efficacy and cost-effectiveness of SiHLE + HIV PMI relative to SiHLE + NEIin maintaining adolescents' condom protected sexual intercourse over an 18-month follow-up period. Consequently, improving the sustainability of HIV prevention programs could have a substantial impact on the intersecting HIV and STD epidemics among African-American female adolescents.
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