Adolescents and HIV

Adolescents and HIV

Effectiveness of an HIV/STD Risk-Reduction Intervention for Adolescents When Implemented by Community-Based Organizations: A Cluster-Randomized Controlled Trial.

The authors evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations. In a cluster randomized controlled trial, 86 community-based organizations that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. Community-based organizations agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Participants were 1707 adolescents, 863 in HIV/STD-intervention community-based organizations and 844 in control-intervention community-based organizations. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR]=1.39; 95% confidence interval [CI]=1.06, 1.84) than were control intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom protected intercourse (β=0.06; 95% CI=0.00, 0.12) than did the control group. This is the first large, randomized intervention trial to demonstrate that community-based organizations can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established.

What happens after risk reduction approaches for adolescents are shown to be effective in randomised controlled trials? Does knowledge translate into programming on the ground? Implementation research can help bridge the gap by demonstrating whether and under what conditions risk reduction approaches work in the real world. This trial among African-American adolescents found that community-based organisations could implement a ‘proven’ intervention and achieve significantly increased condom use outcomes. But importantly, it also found that the effectiveness of the intervention did not increase with more intensive facilitator training. When an efficacious intervention retains its beneficial effects outside tightly controlled research settings and is implemented by community-based organisations without requiring intensive training, it is time to think about introducing it more generally for similar adolescents in similar settings.