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A Randomized Controlled Trial

Ralph J. DiClemente, PhD; Gina M. Wingood, ScD, MPH; Eve S. Rose, MSPH; Jessica M. Sales, PhD; Delia L. Lang, PhD, MPH; Angela M. Caliendo, MD, PhD; James W. Hardin, PhD; Richard A. Crosby, PhD

Arch Pediatr Adolesc Med. 2009;163(12):1112-1121.

Objectives  To evaluate the efficacy of an intervention to reduce incident sexually transmitted disease (STD) and enhance STD/human immunodeficiency virus (HIV)–preventive behaviors and psychosocial mediators.

Design  A randomized controlled trial of an HIV prevention program.

Setting  Clinic-based sample in Atlanta, Georgia.

Participants  African American adolescent females (N = 715), aged 15 to 21 years, seeking sexual health services. Participants completed an audio computer-assisted self-interview and provided self-collected vaginal specimens for STD testing.

Intervention  Intervention participants received two 4-hour group sessions and 4 telephone contacts over a 12-month period, targeting personal, relational, sociocultural, and structural factors associated with adolescents' STD/HIV risk, and were given vouchers facilitating male partners' STD testing/treatment.

Main Outcome Measure  Incident chlamydial infections.

Results  Over the 12-month follow-up, fewer adolescents in the intervention had a chlamydial infection (42 vs 67; risk ratio [RR], 0.65; 95% confidence interval [CI], 0.42 to 0.98; P = .04) or recurrent chlamydial infection (4 vs 14; RR, 0.25; 95% CI, 0.08 to 0.83; P = .02). Adolescents in the intervention also reported a higher proportion of condom-protected sex acts in the 60 days preceding follow-up assessments (mean difference, 10.84; 95% CI, 5.27 to 16.42; P < .001) and less frequent douching (mean difference, –0.76; 95% CI, –1.15 to –0.37; P = .001). Adolescents in the intervention were also more likely to report consistent condom use in the 60 days preceding follow-up assessments (RR, 1. 41; 95% CI, 1.09 to 1.80; P = .01) and condom use at last intercourse (RR, 1.30; 95% CI, 1.09 to 1.54; P = .005). Intervention effects were observed for psychosocial mediators of STD/HIV–preventive behaviors.

Conclusion  Interventions for African American adolescent females can reduce chlamydial infections and enhance STD/HIV–preventive behaviors and psychosocial mediators of STD/HIV–preventive behaviors.

Trial Registration  clinicaltrials.gov Identifier: NCT00633906

Author Affiliations: Department of Behavioral Sciences and Health Education, Rollins School of Public Health (Drs DiClemente, Wingood, Sales, and Lang and Ms Rose), Center for AIDS Research, Social and Behavioral Sciences Core (Drs DiClemente, Wingood, Sales, Lang, and Caliendo and Ms Rose), Division of Infectious Diseases, Epidemiology, and Immunology, Department of Pediatrics (Dr DiClemente), and Department of Pathology and Laboratory Medicine (Dr Caliendo), School of Medicine, and Department of Women's Studies (Dr Wingood), Emory University, Atlanta, Georgia; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia (Dr Hardin); and College of Public Health, University of Kentucky, Lexington (Dr Crosby).

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