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，以适应和评估艾滋病毒预防课程的有效性，为七年级在校利比里亚青年，年龄14-16岁。拟议的干预措施借鉴了循证课程，使自豪的选择（Jemmott等人，1998年），目前正在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）。该研究有三个目的：（1）调整一个基于证据的艾滋病预防计划，在美国的社区设置，在利比里亚的学校教室交付;（2）评估艾滋病预防干预对近端和主要结果的影响，包括延迟性行为开始，增加安全套的使用和近端变量的变化，包括态度，意图和自我效能;（3）评估项目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，我们将根据利比里亚境内学校的环境和情况调整这一社区课程。社区组织成员、卫生教育工作者、学校管理人员和七年级学生将提供数据，通过重点小组和一对一的关键知情人访谈，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，以评估这一适应性课程对改变性风险行为的影响，采用随机对照组设计，学校作为限制性分配单位。四对匹配的初中学校将被随机分配到艾滋病毒预防干预或比较一般健康状况，以评估干预措施对增加安全套使用和延迟利比里亚青年（n=800）之间的性交开始的影响。我们还将评估课程实施的保真度及其对行为结果的影响。透过严格的评估，我们希望能减少在校青少年的危险性行为。通过评估课程保真度及其对行为结果的影响，我们将推进该领域对资源匮乏环境中实施保真度和行为变化之间关系的理解。与我们的利比里亚调查人员合作，实施和评估这一干预措施，我们希望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。 对利比里亚在校青年进行的基于证据的艾滋病毒预防干预的文化适应及其在减少性风险行为方面的功效评估，将为利比里亚学校提供一个基于证据的示范和传播方案。我们的课程保真度及其对行为结果的影响的评估将推进艾滋病预防领域提供一个更细致入微的理解资源匮乏的环境中的实施保真度和行为变化之间的关系。与我们的利比里亚调查人员合作，实施和评估这一干预措施，我们希望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.