African-American adolescent females recently discharged from youth detention centers have a high prevalence of HIV-associated social, psychological and behavioral risk factors. There are, however, no evidence-based interventions (EBI) for this vulnerable population. To address this gap, the proposed study is an exciting opportunity to build upon a link established over the past four years between the Rollins School of Public Health and the Georgia Department of Juvenile Justice to harness the multidisciplinary expertise and experience and of our research team to adapt a CDC-defined EBI, called SiHLE. The proposed study will be conducted in three stages: (1) Adaptation, (2) Implementation, and (3) Evaluation. In Stage 1, Adaptation, we will use a coordinated and systematically guided adaptation process based on our ADAPT-ITT framework to adapt SiHLE to enhance its appropriateness and efficacy for African American adolescent females recently discharged from a youth detention center. In Stage 2, Implementation, we propose to implement the adapted SiHLE intervention using a Phase III randomized controlled trial with a sample of 350 unmarried African-American adolescent females, 13-17 years of age, recruited at the Metro Regional Youth Detention Center (RYDC), in Atlanta, Georgia. Upon discharge, adolescents will be contacted and invited to participate in the proposed study. Eligible adolescents will be scheduled to attend our project site, conveniently located in downtown Atlanta (Citizens Trust Building), to complete baseline procedures. All adolescents will be required to have written informed parental/guardian consent and complete signed assent forms. Adolescents will complete a baseline audio computer-assisted interview (ACASI) assessment. The ACASI is derived from Social Cognitive Theory and the Theory of Gender and Power, the same theoretical framework underlying the original SiHLE intervention. The ACASI is designed to assess adolescents' HIV-associated sexual and substance use behaviors, and other important mediators and moderators of HIV-risk and preventive behaviors. Subsequently, adolescents will be randomized to receive either the adapted SiHLE intervention or a time-equivalent health promotion condition. Adolescents in each study arm complete 4 group sessions on consecutive Saturdays implemented by an African American health educator and co-facilitated by trained African American peer educators. In Stage 3, Evaluation, adolescents will be re-contacted to complete post-intervention ACASI assessments at 3-, 6-, and 12-month follow-up. An intent-to-treat analysis, using linear and logistic generalized estimating equations (GEE) analysis will examine the efficacy of the adapted SiHLE intervention, relative to the health promotion comparison condition, in enhancing HIV-preventive sexual behaviors and psychosocial mediators of safer sex over the 12-month follow-up period.
