Liberia School-Based HIV/STD Prevention Program

描述(由申请人提供)：本申请是一项为期两年的研究，旨在调整和评估针对14-16岁利比里亚7年级在校青年的艾滋病毒预防课程的有效性。拟议的干预措施借鉴了以证据为基础的课程《做出骄傲的选择》(Jemmott等人，1998年)，该课程目前正被其他撒哈拉以南非洲国家(例如加纳、肯尼亚、南非、斯威士兰、利比里亚等)采用。这项拟议的研究有三个目标：(1)采用一个针对美国社区环境设计的循证艾滋病毒预防计划，在利比里亚的学校课堂上提供；(2)评估艾滋病毒预防干预对近期和主要结果的影响，包括推迟性行为开始、增加避孕套使用以及包括态度、意图和自我效能在内的近期变量的变化；以及(3)评估计划实施忠诚度的特征及其与行为结果变化的关系。在拟议的两年期研究的头八个月期间，我们将使这一以社区为基础的课程适应利比里亚境内以学校为基础的环境和背景。社区组织成员、健康教育工作者、学校管理人员和七年级学生将通过焦点小组和一对一关键线人访谈提供数据，指导课程的整合和文化适应。在接下来的16个月里，我们将进行一项队列研究，以学校为受限分配单位，采用随机对照小组设计，评估调整后的课程对改变性危险行为的影响。四对匹配的初中将被随机分配到艾滋病毒预防干预措施或比较一般健康状况，以评估干预措施对增加避孕套使用和推迟利比里亚青年开始性行为的影响(n=800)。我们还将评估课程实施的保真度及其对行为结果的影响。通过对调整后的HIV预防课程的严格评估，我们希望减少在校青少年的性危险行为。通过评估课程保真度及其对行为结果的影响，我们将促进该领域对资源匮乏环境中实施保真度与行为变化关系的理解。我们希望与利比里亚调查人员合作，实施和评估这一干预措施，继续建设利比里亚研究人员及其研究机构的社会和行为研究能力。 公共卫生相关性利比里亚在校青少年基于证据的艾滋病毒预防干预措施的文化适应及其在减少性行为危险行为方面的效果评估将为利比里亚学校提供一个基于证据的方案来模拟和传播。我们对课程保真度及其对行为结果的影响的评估，将通过提供对资源匮乏环境中实施保真度与行为变化之间关系的更细微的理解，推动艾滋病毒预防领域的发展。我们希望与利比里亚调查人员合作，实施和评估这一干预措施，继续建设利比里亚研究人员及其研究机构的社会和行为研究能力。

DESCRIPTION (provided by applicant): This application is for a two year study to adapt and evaluate the efficacy of a HIV prevention curriculum for 7th grade in-school Liberian youths, ages 14-16 years. The proposed intervention draws on an evidence-based curriculum, Making Proud Choices (Jemmott et al., 1998) that is currently being adapted in other Sub-Saharan African countries (e.g., Ghana, Kenya, South Africa, Swaziland, Liberia, etc.). The proposed study has three aims: (1) Adapt an evidence-based HIV prevention program, designed for community settings in the US, to be delivered in school classrooms in Liberia; (2) Evaluate the impact of the HIV prevention intervention on proximal and primary outcomes including delay sexual initiation, increasing condom use and changes in proximal variables including attitudes, intentions and self efficacy; and (3) Assess the characteristics of program implementation fidelity and its relationship to changes in behavioral outcomes. During the first eight months of the proposed two-year study, we will adapt this community-based curriculum to school-based settings and contexts within Liberia. Members of community-based organizations, health educators, school administrators and 7th-grade students will provide data to guide the integration and cultural adaptation of the curriculum through focus groups and one-on-one key informant interviews. Over the next 16 months we will conduct a cohort study to assess the impact of this adapted curriculum on changing sexual risk behaviors using a randomized controlled group design with schools as the restricted assignment unit. Four matched pairs of junior high schools will be randomly assigned to either an HIV prevention intervention or a comparison general health condition to assess the impact of the intervention on increasing condom use and delaying the initiation of sexual intercourse among Liberian youth (n=800). We will also assess the fidelity of curriculum implementation and its impact on behavioral outcomes. Through rigorous evaluation of the adapted HIV prevention curriculum, we hope to reduce sexual risk behaviors of in-school youth. By assessing the curriculum fidelity and its impact on behavioral outcomes, we will advance the field's understanding of the relationship of implementation fidelity and behavior change in resource deprived environments. Working with our Liberian investigators to implement and evaluate this intervention, we expect to continually build the social and behavioral research capacities of Liberian researchers and their research institutions. PUBLIC HEALTH RELEVANCE The cultural adaptation of an evidence based HIV prevention intervention for in-school Liberian youth and the assessment of its efficacy at reducing sexual risk behaviors will provide Liberian schools with an evidence based program to model and disseminate. Our assessment of curriculum fidelity and its impact on behavioral outcomes will advance the HIV prevention field by providing a more nuanced understanding of the relationship between implementation fidelity and behavior changes in resource deprived environments. Working with our Liberian investigators to implement and evaluate this intervention, we expect to continually build the social and behavioral research capacities of Liberian researchers and their research institutions.