Adolescent Abstinence and Unprotected Sex in CyberSenga, an Internet-Based HIV Prevention Program: Randomized Clinical Trial of Efficacy
Adolescent Abstinence and Unprotected Sex in CyberSenga, an Internet-Based HIV Prevention Program: Randomized Clinical Trial of Efficacy
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DOI：
10.1371/journal.pone.0070083
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发表时间：
2013-08-14
期刊：
影响因子：
3.7
通讯作者：
Kiwanuka, Julius P.
中科院分区：
文献类型：
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作者：
Ybarra, Michele L.;Bull, Sheana S.;Kiwanuka, Julius P.
背景：深受艾滋病毒影响的国家迫切需要具有成本效益、可扩展的项目。方法：这项平行组随机对照试验在乌干达姆巴拉拉的四所中学进行。参与者年满 12 岁，报告过去一年的计算机或互联网使用情况，并提供知情的看护者许可和青少年同意。这项名为 CyberSenga 的干预措施是一个为期 5 小时的在线健康性行为计划。干预组的一半人在干预后四个月时进一步随机接受加强注射。控制臂接受“照常治疗”（即学校提供的性编程）。主要结果指标为：1) 安全套使用情况；2) 干预后六个月内过去三个月内的禁欲情况。次要结果是：1）使用安全套；2）干预后三个月禁欲；以及加强剂量暴露后的 6 个月结果。分析是意向治疗。结果：所有 416 名符合条件的青少年都被邀请参加，其中 88% (n = 366) 注册。参与者被随机分配到干预组 (n = 183) 或对照组 (n = 183)； 91 名干预参与者被进一步随机分配至加强组。主要结果中没有发现具有统计学意义的结果。次要结局中：在三个月的随访中，趋势表明干预参与者 (81%) 比对照参与者 (74%；p = 0.08) 更有可能戒酒，在基线时戒酒的青少年中尤其如此 (88% vs. 77%；p = 0.02)。在六个月的随访中，加强治疗组 (80%) 的戒断率高于干预组、无加强治疗组 (57%) 和对照组 (55%) 中的年轻人 (p = 0.15)；他们还报告说，与基线时性活跃的青少年相比，干预组、无加强剂组 (24%) 和对照组 (21%) 青年中无保护性行为的比例 (5%) 较低。结论：CyberSenga 计划可能会在短期内影响禁欲青年的艾滋病毒预防行为，并且在长期内，使用加强剂也可能促进性活跃青年的艾滋病毒预防行为。
Context: Cost-effective, scalable programs are urgently needed in countries deeply affected by HIV.Methods: This parallel-group RCT was conducted in four secondary schools in Mbarara, Uganda. Participants were 12 years and older, reported past-year computer or Internet use, and provided informed caregiver permission and youth assent. The intervention, CyberSenga, was a five-hour online healthy sexuality program. Half of the intervention group was further randomized to receive a booster at four-months post-intervention. The control arm received 'treatment as usual' (i.e., school-delivered sexuality programming). The main outcome measures were: 1) condom use and 2) abstinence in the past three months at six-months' post-intervention. Secondary outcomes were: 1) condom use and 2) abstinence at three-month's post-intervention; and 6-month outcomes by booster exposure. Analyses were intention to treat.Results: All 416 eligible youth were invited to participate, 88% (n = 366) of whom enrolled. Participants were randomized to the intervention (n = 183) or control (n = 183) arm; 91 intervention participants were further randomized to the booster. No statistically significant results were noted among the main outcomes. Among the secondary outcomes: At three-month follow-up, trends suggested that intervention participants (81%) were more likely to be abstinent than control participants (74%; p = 0.08), and this was particularly true among youth who were abstinent at baseline (88% vs. 77%; p = 0.02). At six-month follow-up, those in the booster group (80%) reported higher rates of abstinence than youth in the intervention, no booster (57%) and control (55%) groups (p = 0.15); they also reported lower rates of unprotected sex (5%) compared to youth in the intervention, no booster (24%) and control (21%) groups (p = 0.21) among youth sexually active at baseline.Conclusions: The CyberSenga program may affect HIV preventive behavior among abstinent youth in the short term and, with the booster, may also promote HIV preventive behavior among sexually active youth in the longer term.