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裔美国青少年女性有很高的艾滋病毒相关社会、心理和行为风险因素的流行率。然而，目前还没有针对这一弱势群体的循证干预措施。为了弥补这一差距，拟议的研究是一个令人兴奋的机会，可以利用罗林斯公共卫生学院和佐治亚州少年司法部在过去四年中建立的联系，利用我们研究团队的多学科专业知识和经验，以及我们的研究团队来适应疾控中心定义的EBI，称为 西勒。拟议的研究将分三个阶段进行：(1)适应、(2)实施和(3)评价。在第一阶段，适应，我们将使用基于我们的适应-ITT框架的协调和系统指导的适应过程来适应Sihle，以提高其对最近从青年拘留中心出院的非裔美国青少年女性的适当性和有效性。在第二阶段，实施阶段，我们建议使用第三阶段随机对照试验实施适应性Sihle干预，样本为350名未婚非裔美国人 13-17岁的青春期女性，在佐治亚州亚特兰大的大都会地区青年拘留中心招募。出院后，将联系并邀请青少年参加拟议的研究。符合条件的青少年将被安排参加我们位于亚特兰大市中心(公民信托大楼)的项目现场，以完成基线程序。所有青少年都必须在父母/监护人知情的情况下书面同意，并填写签署的同意书。 青少年将完成基准音频计算机辅助面试(ACASI)评估。ACASI源于社会认知理论和性别与权力理论，这是最初Sihle干预的相同理论框架。ACASI旨在评估青少年与艾滋病毒相关的性行为和药物使用行为，以及艾滋病毒风险和预防行为的其他重要调解人和调节者。随后，青少年将随机接受适应的Sihle干预或同等时间的健康促进条件。 每个研究组的青少年在连续的周六完成4次小组会议，由一名非裔美国人健康教育者实施，并由训练有素的非裔美国人同伴教育者共同推动。在第三阶段，评估，将再次联系青少年，在3个月、6个月和12个月的随访中完成干预后的ACASI评估。意向治疗分析，使用线性和Logistic广义估计方程(GEE)分析，将检验与健康促进比较条件相关的适配的Sihle干预措施在加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.