Liberia School-Based HIV/STD Prevention Program

描述（由申请人提供）：此申请是一项为期两年的研究，以适应和评估利比里亚七年级14-16岁在校青少年预防艾滋病毒课程的效果。拟议的干预措施借鉴了基于证据的课程“做出自豪的选择”（Jemmott等人，1998年），该课程目前正在其他撒哈拉以南非洲国家（如加纳、肯尼亚、南非、斯威士兰、利比里亚等）进行改编。拟议的研究有三个目标：(1)将一个为美国社区环境设计的基于证据的艾滋病毒预防项目应用到利比里亚的学校教室中；(2)评估艾滋病毒预防干预对近端和主要结局的影响，包括延迟性行为开始、增加安全套使用和近端变量的变化，包括态度、意图和自我效能感；(3)评估项目实施保真度的特征及其与行为结果变化的关系。在拟议的为期两年的研究的头八个月，我们将使这种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、卫生教育工作者、学校行政人员和七年级学生将提供数据，通过焦点小组和一对一关键信息提供者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，以随机对照设计为单位，以学校为限制任务单位，评估这种改编课程对改变性危险行为的影响。四对配对的初中将被随机分配到艾滋病毒预防干预组或比较一般健康状况组，以评估干预对利比里亚青年中增加避孕套使用和推迟开始性交的影响（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改变关系的理解。与我们的利比里亚调查人员一起实施和评估这一干预措施，我们期望继续建立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.