Adapting SiHLE for Detained African American Adolescent Females

描述（由申请人提供）：最近从青年拘留中心出院的非洲裔美国青少年女性具有艾滋病毒相关的社会，心理和行为风险因素的高患病率。然而，没有针对这一弱势群体的循证干预措施。为了解决这一差距，拟议的研究是一个令人兴奋的机会，建立在过去四年罗林斯公共卫生学院和格鲁吉亚少年司法部之间建立的联系，利用多学科的专业知识和经验，以及我们的研究团队，以适应CDC定义的EBI，称为 SiHLE。拟议的研究将分三个阶段进行：（1）适应，（2）实施和（3）评估。在第一阶段，适应，我们将使用一个协调和系统指导的适应过程的基础上，我们的ADAPT-ITT框架，以适应SiHLE，以提高其适当性和有效性，为非洲裔美国青少年女性最近从青年拘留中心出院。在第二阶段，实施，我们建议实施适应SiHLE干预使用III期随机对照试验的样本350未婚非洲裔美国人 13-17岁的青少年女性，在格鲁吉亚亚特兰大的Metro地区青年拘留中心（RYDC）招募。出院后，将联系青少年并邀请其参加拟定研究。符合条件的青少年将被安排参加我们的项目现场，位于亚特兰大市中心（公民信托大厦），以完成基线程序。所有青少年都必须获得父母/监护人的书面知情同意书和完整的签名同意书。 青少年将完成基线音频计算机辅助面试（ACASI）评估。ACASI源自社会认知理论和性别与权力理论，与SiHLE最初干预的理论框架相同。ACASI旨在评估青少年与艾滋病毒相关的性行为和物质使用行为，以及其他重要的艾滋病毒风险和预防行为的介导者和调节者。随后，青少年将随机接受调整后的SiHLE干预或时间等效的健康促进条件。 每个研究组的青少年在连续的星期六完成4个小组会议，由一名非裔美国人健康教育工作者实施，并由受过培训的非裔美国人同伴教育工作者共同促进。在第3阶段评价中，将在3个月、6个月和12个月随访时再次联系青少年，以完成干预后ACASI评估。使用线性和逻辑广义估计方程（GEE）分析的意向治疗分析将检查调整后的SiHLE干预措施相对于健康促进比较条件在增强艾滋病毒预防方面的有效性。 在12个月的随访期内，性行为和安全性行为的心理社会中介。

DESCRIPTION (provided by applicant): African-American adolescent females recently discharged from youth detention centers have a high prevalence of HIV-associated social, psychological and behavioral risk factors. There are, however, no evidence-based interventions (EBI) for this vulnerable population. To address this gap, the proposed study is an exciting opportunity to build upon a link established over the past four years between the Rollins School of Public Health and the Georgia Department of Juvenile Justice to harness the multidisciplinary expertise and experience and of our research team to adapt a CDC-defined EBI, called SiHLE. The proposed study will be conducted in three stages: (1) Adaptation, (2) Implementation, and (3) Evaluation. In Stage 1, Adaptation, we will use a coordinated and systematically guided adaptation process based on our ADAPT-ITT framework to adapt SiHLE to enhance its appropriateness and efficacy for African American adolescent females recently discharged from a youth detention center. In Stage 2, Implementation, we propose to implement the adapted SiHLE intervention using a Phase III randomized controlled trial with a sample of 350 unmarried African-American adolescent females, 13-17 years of age, recruited at the Metro Regional Youth Detention Center (RYDC), in Atlanta, Georgia. Upon discharge, adolescents will be contacted and invited to participate in the proposed study. Eligible adolescents will be scheduled to attend our project site, conveniently located in downtown Atlanta (Citizens Trust Building), to complete baseline procedures. All adolescents will be required to have written informed parental/guardian consent and complete signed assent forms. Adolescents will complete a baseline audio computer-assisted interview (ACASI) assessment. The ACASI is derived from Social Cognitive Theory and the Theory of Gender and Power, the same theoretical framework underlying the original SiHLE intervention. The ACASI is designed to assess adolescents' HIV-associated sexual and substance use behaviors, and other important mediators and moderators of HIV-risk and preventive behaviors. Subsequently, adolescents will be randomized to receive either the adapted SiHLE intervention or a time-equivalent health promotion condition. Adolescents in each study arm complete 4 group sessions on consecutive Saturdays implemented by an African American health educator and co-facilitated by trained African American peer educators. In Stage 3, Evaluation, adolescents will be re-contacted to complete post-intervention ACASI assessments at 3-, 6-, and 12-month follow-up. An intent-to-treat analysis, using linear and logistic generalized estimating equations (GEE) analysis will examine the efficacy of the adapted SiHLE intervention, relative to the health promotion comparison condition, in enhancing HIV-preventive sexual behaviors and psychosocial mediators of safer sex over the 12-month follow-up period.