SEPA III: The Effectiveness Trial

这项研究的首要目标是减少西班牙裔和非西班牙裔女性在艾滋病毒感染方面的种族差异。这一目标将通过两个目标来实现：目标1是建立一种新的和有效的伙伴关系，通过将SEPA（即，健康、教育、自我预防；健康、教育、预防和自我保健）和基于证据的艾滋病毒预防干预措施纳入社区环境，同时评估机构和推动者的特点以及改进做法、实施、忠诚和可持续性的准备情况，改善少数群体的健康；目的2是评估SEPA在社区机构人员在现实环境中分娩时提高西班牙裔妇女艾滋病毒预防行为和降低性传播感染发生率的有效性。300名年龄在18岁至50岁之间的西班牙语女性将从迈阿密-戴德县公共卫生部门的四个站点之一招募，并随机分配到SEPA或等候名单控制条件。

The proposed study's overarching goal is to reduce the ethnic disparities in HIV between Hispanic and non-Hispanic women. This goal will be accomplished by two aims: Aim 1 is to establish a novel and effective partnership to improve minority health by integrating SEPA (i.e., Salud, Educacion, Prevencion y Autocuidado; Health, Education, Prevention and Self-Care) an evidenced based, HIV preventive intervention into community setting while assessing agency and facilitator characteristics and readiness for practice improvement, implementation, fidelity, and sustainability; and Aim 2 is to evaluate the effectiveness of SEPA to increase HIV prevention behaviors and to reduce the incidence of STIs for Hispanic women when delivered in a real-world setting by community agency personnel. 300 Spanish-speaking Hispanic women between the ages of 18 and 50 who are sexually active will be recruited from one of four Miami-Dade County Public Health Department sites and randomized to either SEPA or a Wait-List Control condition. SEPA has been evaluated and found to be efficacious in two separate randomized controlled trials. In the first study (Peragallo et al., 2005), SEPA was shown to be efficacious relative to a Wait List Control condition in increasing the frequency of condom use, increasing partner communication regarding sex, and increasing HIV knowledge. In the second study (Peragallo et al., 2011), SEPA was efficacious (relative to Wait List Control) in reducing the incidence of STIs, in increasing the frequency of condom use, increasing partner communication, reducing intimate partner violence, and decreasing alcohol use. Partner communication regarding sex mediated the effects of the intervention on frequency of condom use. Hierarchical Linear Modeling (HLM) will be used to test (HI a): SEPA will be more effective relative to Wait List Control in reducing unprotected sexual behavior (defined as frequency of condom use in the past 90 days) over time. Logistic Regression will be used to test (H2a): SEPA will be more effective relative to Wait List Control in reducing STI incidence (specifically, the incidence of Neisseria gonorrhea. Chlamydia trachomatis, and Syphilis). Additionally, HLM and logistic regression, respectively, will be used to determine whether (H1b): The effect of SEPA on unprotected sexual behavior will be partially mediated by improvements in sexual communication with partner; and (H2b) The effect of SEPA on STI incidence will be partially mediated by improvements in sexual communication with partner and reductions in unprotected sexual behavior.