HIV Prevention Maintenance for African American Teens

Principal Investigator: Ralph DiClemente, Ph.D.

Emory University, School of Public Health

Abstract:

African-American adolescent females are a population at high risk for HIV infection. Recent findings suggest that culturally and gender appropriate HIV interventions can significantly reduce HIV-associated sexual risk behaviors among this vulnerable population. While HIV sexual risk-reduction interventions are effective in the short term, the development and evaluation of innovative strategies designed to enhance the long term maintenance of HIV-preventive sexual behaviors remains a public health priority.

The proposed study uses a type of Phase III, randomized controlled trial, known as a supplemental treatment trial.¹ Supplemental treatment trials are combined modality studies, in which participants receive a “primary” treatment and, subsequently, receive a different treatment modality designed to enhance the effects of the primary treatment. This trial design provides an appropriate conceptual and methodological framework to evaluate the primary aim. The primary aim of the proposed study is to determine the efficacy of an HIV maintenance prevention intervention to sustain condom protected sexual intercourse among African-American adolescent females over an 18-month follow-up period.

We propose to recruit 700 African-American female adolescents’ between the ages of 14-18 currently seeking services at Planned Parenthood in Atlanta, Georgia. Eligible adolescents will complete a baseline audio computer-assisted interview (ACASI) assessment. The ACASI interview is derived from Social Cognitive Theory and the Theory of Gender and Power. The ACASI is designed to assess adolescents’ sexual risk behaviors, and theoretically and empirically important mediators and moderators of HIV-preventive behavior. Subsequently, adolescents will be randomized to either an experimental condition or an attention control comparison condition. Adolescents in both conditions receive the same primary treatment, the group-delivered SiHLE HIV intervention.

The SiHLE HIV intervention was developed and evaluated by Drs. DiClemente and Wingood. SiHLE is a gender and culturally-appropriate HIV sexual risk-reduction intervention for African-American female adolescents. In our recently completed randomized controlled trial, adolescents (N=522) randomized to the SiHLE HIV intervention reported significantly more condom-protected episodes of sexual intercourse and enhanced levels of key mediators of HIV prevention over an 18-month follow-up compared to an attention control comparison condition.

In the proposed study, adolescents randomized to the experimental condition participate in the SiHLE HIV intervention and subsequently receive the supplemental intervention, an individualized telephone-delivered HIV Prevention Maintenance Intervention (SiHLE+HIV PMI). Adolescents randomized to the comparison condition participate in the SiHLE HIV intervention however, they do not receive the supplemental HIV prevention maintenance intervention. Adolescents in this condition subsequently receive a time- and dose-equivalent individualized telephone-delivered Nutrition Education Intervention (SiHLE+NEI). The aims of the proposed supplemental treatment trial are specified below.

Specific Aims:

1. To evaluate the efficacy of the SiHLE+HIV Prevention Maintenance Intervention condition, relative to the SIHLE+Nutrition Education Intervention condition, in enhancing female adolescents condom-protected sexual intercourse over an 18-month follow-up.

2. To evaluate the efficacy of the SiHLE+HIV Maintenance Prevention Intervention condition, relative to the SiHLE+Nutrition Education Intervention condition, in enhancing key mediators of condom-protected sexual intercourse over an 18-month follow-up.

3. To evaluate the cost-effectiveness of the SiHLE+HIV Prevention Maintenance Intervention condition, relative to the SiHLE+Nutrition Education Intervention condition, in enhancing condom-protected sexual intercourse over an 18-month follow-up.