Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN Dean College of Nursing

Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN Dean College of Nursing Senior Associate Vice President USF Health Professor of Nursing and Public Health

Lessons Learned from Conducting a Community-based HIV Prevention RCT with Urban Adolescent Girls

Transforming Healthcare, Transforming Lives USF College of Nursingc

University of South Florida – College of NursingTampa, Florida

National Institute of Health/National Institute of Nursing Research (R01 NR008194).


• Finding innovative approaches to unique challenges encountered with sexual risk-reduction interventions in RCTs conducted in urban settings with adolescent girls.

Introduction


• 72% of new HIV infections in adolescents result from unprotected sexual contact; 89% in females.

• 19 million STI cases annually: Adolescent girls higher rates of GC and CT than similarly aged males or older persons of either gender.

• Unintended pregnancy rates increasing in older adolescents

• 39% of sexually active youth report no condom use during last sexual intercourse

Problem: HIV in Adolescent Girls


Adolescence: Window of Opportunity

Studies in countries with generalized AIDS epidemics show that women become infected at younger ages than men, usually by older men. Men’s infections tend to occur at later ages.


Health Improvement Project for Teens (HIPTeens)

Enroll*

SRR 4 Sessions Reunion Reunion Data

CTL 4 Sessions Reunion Reunion Data

Pre 1 wk post

3 mo postACASI

Data Points:

12 mo post

6 mo post

R

*N=738, ages 15-19


Purpose

• Evaluate a RCT gender-specific sexual risk-reduction intervention, targeting low-income, urban, sexually active adolescent girls.


Recruitment Sites• Clinical adolescent health centers• Youth development programs providing

services of economically disadvantaged• Family planning agencies• Health fairs and local high schools• Included use of posters, self-referral, and

friend-referral


Participants’ age and risk behaviors

Baseline Data

Self-reported: Age at first vaginal sexual experience 14.4 years Age at first oral sexual experience 15.2 years Age at first anal sexual experience 15.7 years

x

Self-reported: % Used marijuana w/in past 3 months 41% Binge drank w/in past 3 months 28% Used drugs before sex 24% Used alcohol before sex 23% History of actual penetrative sex against will using physical force

16%

Ever treated for an STI 12% Diagnosed by urine sample: % Percentage with positive STI 12%


Results

• HIPTEENS participants showed statistically significan changes in: – Fewer episodes of vaginal sex at all follow-ups – Fewer episodes of unprotected vaginal sex at 3 and 12 month

follow-ups– Decrease in total number of partners at 6 month

follow-up– Higher rates of abstinence at 3 and 12 month follow-ups

• Medical record audits documented 50% reduction in positive pregnancy tests at 12-months


• A number of challenges threatened intervention integrity:– Complexities of Urban setting– Psychosocial complexities of participants– Topic area (sexual risk reduction)– Research Team

Challenges


• Safety Issues– Weapons– Gang involvement– External intrusions/disruptions

• Protestors• Male partners

Complexities of Urban Setting


• Developmental Stage– Adolescents reason differently from adults– Low future time perspective influences actions

• Social Issues– Food Insecurity/Hunger– Income generating schemes– Unstable housing

Participant Psychosocial Complexities


• Discussion of Sex– Opens Pandora’s box– Reconcile with participant’s other info sources

• Media Impact– Music– Movies– Media

Topic Area


• Length of recruiter employment• Greater retention• Retention of staff over multiple years

• Intervention Facilitator Characteristics• Age important

• Capacity Building– Dress Code– Intervention Fidelity/Integrity

• Intellectual Property Infringement

Research Team


• RCT embedded within an RCL– Rocky Circumstances of Life

• Social issues not evenly distributed– Disparities among African Americans– Adolescents more vulnerable than adults

• Anticipate and accommodate needs– Highest risk groups likely to have high needs– Will impact translatability to practice

What Did we Learn?


• Conducting RCTs with adolescents in urban communities requires “Out of the Box” thinking to anticipate and address challenges to intervention implementation

Out of the Box Thinking


Implementation Workshop

Documents

Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN Dean College of Nursing