African-American adolescent females recently discharged from youth detention centers have a highprevalence of HIV-associated social, psychological and behavioral risk factors. There are, however, noevidence-based interventions (EBI) for this vulnerable population. To address this gap, the proposedstudy is an exciting opportunity to build upon a link established over the past four years between theRollins School of Public Health and the Georgia Department of Juvenile Justice to harness themultidisciplinary expertise and experience and of our research team to adapt a CDC-defined EBI, calledSiHLE. 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 guidedadaptation process based on our ADAPT-ITT framework to adapt SiHLE to enhance its appropriatenessand efficacy for African American adolescent females recently discharged from a youth detentioncenter. In Stage 2, Implementation, we propose to implement the adapted SiHLE interventionusing a Phase III randomized controlled trial with a sample of 350 unmarried African-Americanadolescent 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 theproposed study. Eligible adolescents will be scheduled to attend our project site, conveniently locatedin downtown Atlanta (Citizens Trust Building), to complete baseline procedures. All adolescents will berequired to have written informed parental/guardian consent and complete signed assent forms.Adolescents will complete a baseline audio computer-assisted interview (ACASI) assessment. TheACASI is derived from Social Cognitive Theory and the Theory of Gender and Power, the sametheoretical framework underlying the original SiHLE intervention. The ACASI is designed to assessadolescents' HIV-associated sexual and substance use behaviors, and other important mediators andmoderators of HIV-risk and preventive behaviors. Subsequently, adolescents will be randomized toreceive 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 anAfrican American health educator and co-facilitated by trained African American peer educators. InStage 3, Evaluation, adolescents will be re-contacted to complete post-intervention ACASIassessments at 3-, 6-, and 12-month follow-up. An intent-to-treat analysis, using linear and logisticgeneralized estimating equations (GEE) analysis will examine the efficacy of the adapted SiHLEintervention, relative to the health promotion comparison condition, in enhancing HIV-preventivesexual behaviors and psychosocial mediators of safer sex over the 12-month follow-up period.
of the Research to Public Health Given the lack of an evidence-based intervention for recently discharged African-American adolescent females, this could be amongst the first evidence-based intervention designed for this growing and vulnerable population. Dissemination of the adapted SiHLE intervention to other juvenile justice systems and community-based AIDS service organizations has the potential to reach a population substantially impacted by the HIV epidemic.
