Translating an effective group-based HIV prevention program to a program delivered primarily by a computer: methods and outcomes

Digital HPV education to increase vaccine uptake among low income women

Objective

The objective of this formative study was to gather women's perspectives in the design and communication modalities of a health kiosk set within a Planned Parenthood setting to promote patient education about the Human papillomavirus (HPV) and to motivate uptake of the HPV vaccine.

Methods

Twenty-four women aged 18-35 participated in in-depth one-on-one interviews at a Planned Parenthood health center, which were analyzed in code-associated categories using NVivo11 Pro.

Results

Most women showed receptivity to using an on-site health kiosk, as well as QR codes linked to text messages, to receive HPV-related health information outside of the clinic setting and reminders. Participants provided suggestions for kiosk design and communication modalities.

Conclusions

Among low-income women we interviewed at Planned Parenthood, increasing HPV vaccination rates necessitates engaging digital health tools which incorporate both the preferences and needs of vulnerable populations.

Innovation

Designing a point-of-service health kiosk that 1) draws on user preferences early in the design phase, 2) integrates multiple communication technologies, and 3) disseminates culturally grounded HPV vaccination decisions narratives that are tailored to vaccination awareness level is a promising approach in reducing barriers to HPV vaccine education and vaccine uptake among low-income women at safety-net clinics.

A Review of Serious Gaming as an Intervention for HIV Prevention

PURPOSEOF REVIEW

Young people face the highest number of new HIV infections globally. With today's increasing access to smartphones, serious games have been viewed as an effective means of improving knowledge and behavioral outcomes. This systematic review describes current HIV prevention serious games and their relationship with HIV-related knowledge and behavioral outcomes.

RECENT FINDINGS

A search of HIV prevention serious games was conducted using PubMed, CINAL, IEEE, Web of Science, and Google Scholar. A total of 31 papers were identified, which consist of 20 studies and 11 protocols. Results for knowledge, attitudes, intentions, and behaviors were mixed. Two interventions reported improvement in PrEP usage and optimal dosing. Gaming appears to be a viable and engaging method to improve knowledge, attitudes, and behavioral outcomes to promote HIV prevention among diverse groups of adolescents and young adults globally. However, additional research is needed to understand how to implement this modality effectively.

Development and Cultural Adaptation of a Computer-Delivered and Multi-Component Alcohol Reduction Intervention for Russian Women Living with HIV and HCV

Background:

There is elevated prevalence of problem drinking among Russian women living with HIV and HCV co-infection. This paper describes the development and cultural adaptation of a multi-component alcohol reduction intervention incorporating a brief, computer-delivered module for Russian women living with HIV and HCV co-infection.

Methods:

The format and content of the intervention were adapted to be linguistic-, cultural-, and gender-appropriate using the ADAPT-ITT framework. A computer-delivered module and brief clinician-delivered individual and telephone sessions were developed.

Results:

We describe the theoretical foundations of the intervention, the cultural adaptation of the intervention, and overview the content of the intervention’s multiple components.

Discussion:

Interventions to reduce alcohol use that can be integrated within Russian HIV treatment centers are urgently needed. If efficacious, the culturally-adapted intervention offers the promise of a cost-effective, easily disseminated intervention approach for Russian women living with HIV/HCV co-infection engaging in problematic alcohol use.

Electronic Dissemination of a Web-Based Video Promotes PrEP Contemplation and Conversation Among US Women Engaged in Care at Planned Parenthood

We evaluated the acceptability and impact of a web-based PrEP educational video among women (n = 126) by comparing two Planned Parenthood centers: one assigned to a Web Video Condition and one to a Standard Condition. Most women reported the video helped them better understand what PrEP is (92%), how PrEP works (93%), and how to take PrEP (92%). One month post-intervention, more women in the Web Video Condition reported a high level of comfort discussing PrEP with a provider (82% vs. 48%) and commonly thinking about PrEP (36% vs. 4%). No women with linked medical records initiated PrEP during 1-year follow-up.

A Brief Computer-Based Sexual Assault Risk Reduction Program: A Feasibility, Acceptability, and Preliminary Efficacy Pilot Study

Sexual victimization among college women is a common problem, necessitating the development of risk reduction programs that are both effective and acceptable to this population. Computer-based programs may be a cost- and time-effective option. This pilot study sought to examine the feasibility, acceptability, and preliminary efficacy of a computer-based risk reduction program. A total of 136 collegiate women were randomly assigned to receive either a computer-based risk reduction program or an educational program about campus resources (active control condition). Measures included predicted use of resistance techniques, risk detection, and acceptability of the program. No participants dropped out of the study, and acceptability ratings were generally high. Women reported learning new material from the program, preferring the computer-based program to large-group programs, and believing that other undergraduate women would benefit from the program. Furthermore, women reported they did not experience significant emotional disturbance due to the material. In addition, postintervention, the risk reduction program group had significantly better risk detection compared with the control group. The control group evidenced a reduction in predicted use of assertive resistance between pre- and postintervention assessments, while the risk reduction program group did not. Given preliminary support for the feasibility, acceptability, and preliminary efficacy of a brief, computerized risk reduction program, further research on computerized, online risk reduction programs, such as the one in this study, appears warranted.

Developing Culturally Tailored mHealth Tools to Address Sexual and Reproductive Health Outcomes Among Black and Latina Women: A Systematic Review

BACKGROUND

In addressing the sexual and reproductive health (SRH) disparities for Black and Latina women, there is a need for the development of innovative programs, framed using theoretical underpinnings that are culturally and contextually tailored so that they align with lived experiences. Mobile health (mHealth) interventions offer considerable potential as a means of providing effective SRH education and services. However, there has been a lack of research assessing culturally and contextually tailored mHealth SRH interventions for Black and Latina women.

METHOD

A comprehensive literature search was undertaken using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature was reviewed to evaluate whether a culturally and contextually tailored approach was utilized in the development and implementation of mHealth interventions for Black and Latina women.

RESULTS

A total of 12 articles were included in our synthesis, which encompassed mobile phone-, telephone-, and computer-based mHealth interventions for Black and Latina women. Cultural and/or gender-specific tailoring was included in 10 studies. Reduction of risky sexual behaviors and increased contraception usage were reported in 92% (n = 11) of the studies. Interventions that incorporated tailored content and fostered interaction reported high rates of follow-up.

CONCLUSIONS

Tailored mHealth interventions can be effective in promoting behavior change and improving SRH outcomes for Black and Latina women. However, there is a need for more research assessing user engagement and retention for Black and Latina women, and whether improvements in SRH outcomes are sustainable over the long term.

A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study

BACKGROUND

HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women.

OBJECTIVE

This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app.

METHODS

We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions.

RESULTS

Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer-friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively.

CONCLUSIONS

This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway.

Blended Learning for Sexual Health Education: Evidence Base, Promising Practices, and Potential Challenges

BACKGROUND

Blended learning is a combination of online learning and face-to-face instruction, and is increasingly being used in K-12 settings. A meta-analysis conducted for the Department of Education suggests blended learning is more effective than either group-based or online learning alone, particularly in K-12 settings.

METHODS

This paper provides a narrative review of the literature from 2000 to 2017 on blended learning as it applies to sexual health education programs, and discusses outcomes, best practices and potential challenges of blended learning that may be important for practitioners and researchers considering this approach.

RESULTS

Blended learning approaches are being used successfully in sexual health education programs, including school-based programs, and have yielded positive behavioral and psychosocial changes. Similar to traditional group-based programs, not all outcomes tested in these programs showed positive impact. Designing blended learning programs can be challenging, but there is a large best-practice literature that can inform practitioners interested in using it.

CONCLUSIONS

Blended learning approaches are viable for sexual health education and offer numerous advantages to group-based only programs, such as confidential personalization and an instructional approach that is familiar and engaging for participants.

Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey

Background

Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format.

Objective

The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women.

Methods

A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants’ perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video.

Results

Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=−.814; P=.004), not having unprotected sex in the last 3 months (beta=−.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=−.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=−.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women.

Conclusions

Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.

Video Intervention to Increase Perceived Self-Efficacy for Condom Use in a Randomized Controlled Trial of Female Adolescents

STUDY OBJECTIVE

To assess the effects of the Seventeen Days interactive video on young women's perceived self-efficacy for using condoms 6 months after being offered the intervention, relative to a control.

DESIGN

Multisite randomized controlled trial.

SETTING

Twenty participating health clinics and county health departments in Ohio, Pennsylvania, and West Virginia.

PARTICIPANTS

Sexually active female adolescents ages 14 to 19 years.

INTERVENTIONS

Seventeen Days (treatment intervention; sex education) vs Driving Skills for Life (control intervention; driving education).

MAIN OUTCOME MEASURES

Perceived self-efficacy for condom use.

RESULTS

Participants in the Seventeen Days group reported higher perceived condom acquisition self-efficacy after 6 months than those in the driving group. This finding held after controlling for baseline self-efficacy scores and other covariates.

CONCLUSION

The Seventeen Days program shows promise to improve perceived self-efficacy to acquire condoms among sexually active female adolescents-an important precursor to behavior change.

Use of Technology for HIV Prevention Among Adolescent and Adult Women in the United States

Although the proportion of new HIV infections in the USA among women has decreased over the last few years, still, approximately 20 % of new infections occur annually among adolescent and adult women. The development of effective evidence-based prevention interventions remains an important approach to further decreasing these numbers. Technology-delivered prevention interventions hold tremendous potential due, in part, to their ability to reach beyond the walls of brick-and-mortar intervention sites to engage individuals where they are. While most technology-delivered interventions have focused on adolescents and men who have sex with men, much fewer have specifically targeted adolescent or adult women despite evidence showing that interventions tailored to specific target populations are most effective. We summarize the recently published literature on technology-delivered HIV prevention interventions for US adolescent and adult women and provide suggestions for next steps in this nascent but emergent area of prevention research.

Developing a Video-Based eHealth Intervention for HIV-Positive Gay, Bisexual, and Other Men Who Have Sex with Men: Study Protocol for a Randomized Controlled Trial

BACKGROUND

Gay, bisexual, and other men who have sex with men (GBMSM) accounted for 67% of new US human immunodeficiency virus (HIV) infections in 2012; however, less than 40% of HIV-positive GBMSM are virally suppressed. Preventing transmission from virally unsuppressed men who have condomless anal sex (CAS) with serodiscordant partners is a public health imperative. New HIV infections in GBMSM are attributed in part to online access to sex partners; therefore, low-cost eHealth interventions are a unique opportunity to reach men where they meet partners.

OBJECTIVE

To describe the protocol of a randomized controlled trial evaluating whether video-based messaging delivered online may lead to reductions in serodiscordant CAS and increased HIV disclosure.

METHODS

Sex Positive!([+]) is a two-arm, phase III, video-based randomized controlled trial delivered online to GBMSM living with HIV. Participants in the intervention arm receive 10 video vignettes grounded in social learning and social cognitive theories that are designed to elicit critical thinking around issues of HIV transmission and disclosure. Participants in the attention control arm receive 10 video vignettes that focus on healthy living. All videos are optimized for mobile viewing. The study protocol includes five online assessments conducted over a 1-year period among 1500 US white, black, or Hispanic/Latino GBMSM living with HIV who report suboptimal antiretroviral therapy (ART) adherence or a detectable viral load in the past 12 months and recent CAS (past 6 months) with HIV-negative or unknown status male partners. Compared to the control arm, we hypothesize that men who watch the intervention videos will report at 12-month follow-up significantly fewer serodiscordant CAS partners, increased HIV disclosure, and improved social cognition (eg, condom use self-efficacy, perceived responsibility).

RESULTS

Participant recruitment began in June 2015 and ended in December 2015.

CONCLUSIONS

This protocol describes the underlying theoretical framework and measures, study design, recruitment challenges, and antifraud measures for an online, video-based randomized controlled trial that has the potential to decrease HIV transmission risk behaviors among HIV-positive GBMSM who struggle with ART adherence. The Sex Positive!([+]) intervention allows for participation through multiple Internet-based mediums and has the potential to reach and engage a broader population of HIV-positive GBMSM who are virally unsuppressed.

CLINICALTRIAL

ClinicalTrials.gov NCT02023580; https://clinicaltrials.gov/ct2/show/NCT02023580 (Archived by WebCite at http://www.webcitation.org/6iHzA8wRG).

SiHLEWeb.com: Development and usability testing of an evidence-based HIV prevention website for female African-American adolescents

African-American adolescent girls are at disproportionate risk for HIV infection. Although numerous evidence-based risk-reduction interventions exist, dissemination and implementation resources remain limited, and prevention services remain notably inaccessible to the very populations at highest risk for HIV infection. Internet delivery of HIV risk-reduction programming has promise as a mechanism for extending the reach of existing prevention efforts and overcoming barriers associated with traditional service delivery. This article (1) details the development process for the creation of SiHLEWeb, a web-adapted version of an evidence-based, culturally informed HIV prevention program traditionally delivered to female African-American adolescents via an in-person group format, and (2) presents findings from quantitative and qualitative usability testing conducted among 18 African-American girls (13-18 years). Results suggest that users found the website improved knowledge and learning, was helpful, efficient to use, and generally attractive. Users reported some concerns about website navigation. Implications for Internet delivery of health prevention programming are discussed.

Efficacy of It's Your Game-Tech: A Computer-Based Sexual Health Education Program for Middle School Youth

PURPOSE

Few computer-based HIV, sexually transmitted infection (STI), and pregnancy prevention programs are available, and even fewer target early adolescents. In this study, we tested the efficacy of It's Your Game (IYG)-Tech, a completely computer-based, middle school sexual health education program. The primary hypothesis was that students who received IYG-Tech would significantly delay sexual initiation by ninth grade.

METHODS

We evaluated IYG-Tech using a randomized, two-arm nested design among 19 schools in a large, urban school district in southeast Texas (20 schools were originally randomized). The target population was English-speaking eighth-grade students who were followed into the ninth grade. The final analytic sample included 1,374 students. Multilevel logistic regression models were used to test for differences in sexual initiation between intervention and control students, while adjusting for age, gender, ethnicity, time between measures, and family structure.

RESULTS

There was no significant difference in the delay of sexual activity or in any other sexual behavior between intervention and control students. However, there were significant positive between-group differences for psychosocial variables related to STI and condom knowledge, attitudes about abstinence, condom use self-efficacy, and perceived norms about sex. Post hoc analyses conducted among intervention students revealed some significant associations: "full exposure" (completion of all 13 lessons) and "mid-exposure" (5-8 lessons) students were less likely than "low exposure" (1-4 lessons) students to initiate sex.

CONCLUSIONS

Collectively, our findings indicate that IYG-Tech impacts some determinants of sexual behavior, and that additional efficacy evaluation with full intervention exposure may be warranted.

Behavioral Decision Research Intervention Reduces Risky Sexual Behavior

Although adolescents are at disproportionate risk for sexually transmitted infections, most sex education programs have shown little effect on sexual behavior. An interactive video intervention developed by our team has been identified as one of a few programs that have been documented to reduce sexually transmitted infections in this population. Building on behavioral decision research, we used a mental models approach to interview young women about their sexual decisions, finding, among other things, the strong role of perceived social norms. We based our intervention on these results, aiming to help young women identify and implement personally and socially acceptable decision strategies. A randomized controlled trial found that the video reduced risky sexual behavior and the acquisition of chlamydia infection. We recently revised the video to suit more diverse audiences, and upgraded it to modern standards of cinematography and interactivity. It is now in field trial.

A systematic review of sexual health interventions for adults: narrative evidence

Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996-2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.

A Systematic Review and Meta-analysis of Interventions for Sexual Health Promotion Involving Serious Digital Games

OBJECTIVE

Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to the individual's needs and may be intrinsically motivating. This meta-analysis investigates the effectiveness of interventions for sexual health promotion that use serious games.

MATERIALS AND METHODS

A database search was conducted in PubMed, Web of Science, CINAHL, and PsycINFO for publications before the end of July 2013. Serious digital games studies measuring effects on behavior or its determinants, using a control condition, allowing the calculation of an effect size (Hedges' g, random-effects model) were included.

RESULTS

Seven game studies for sexual health promotion were included. These showed positive effects on determinants (g=0.242; 95 percent confidence interval, 0.129, 0.356), albeit of small effect size. The effects on behavior, measured in only two studies, were not significant (g=0.456; 95 percent confidence interval, -0.649, 1.561). Most games did not use many game features that are considered to be immersive or enhancing flow. Instead, there was a strong reliance on pure gamification features, such as rewards and feedback.

CONCLUSIONS

The effectiveness of the next generation of games may be enhanced by building on the behavioral change and educational gaming literatures (e.g., using role-play and simulation game formats, individual tailoring, offering adaptation in the difficulty of the challenge, and amount and timing of the feedback). There is a need for studies with rigorous evaluations of game effectiveness, longer-term follow-up, and using measures of behavior rather than merely their determinants.

Use of digital media technology for primary prevention of STIs/HIV in youth

STUDY OBJECTIVE

The relevant literature was reviewed to identify issues in research evaluating digital media technology (DMT) interventions for the primary prevention of STIs/HIV in adolescents and young adults.

METHOD

A literature search with relevant key terms was conducted in PubMed, for articles with studies that included: (a) participants between 11-29 years; (b) use of one or more of the following forms of DMT: interactive digital video or CD-ROM, computer, text messaging, or Internet; (c) evaluation of an STI/HIV primary prevention intervention; and (d) use of a cognitive, psychosocial, behavioral, or biological outcome.

RESULTS

Twenty-nine studies were identified and included in the review. Based on the review of these studies, 7 main issues were discussed and recommendations for improving future research were offered. The 7 main issues were: (a) need for a balance between universal application and specific sub-group focus, (b) lack of a developmental framework, (c) challenge of applying DMT in resource limited contexts, (d) rapidly changing nature of DMT, (e) lack of biological outcomes, (f) lack of comparison/control groups to assess the impact of DMT, and (g) limited temporal follow-up.

CONCLUSIONS

There is increasing literature evaluating the effectiveness of DMT for preventing STIs/HIV among adolescents and young adults. A careful consideration of 7 main issues identified in the literature can improve the design and evaluation of these interventions and enhance our understanding of their effectiveness.

Sexual health interventions: a meta-analysis

In the second of two companion papers, we conducted a meta-analysis of sexual health interventions in three domains. The interventions chosen for the meta-analysis were a subset of studies presented in a narrative review (the first of the two companion papers); these in turn were selected on the basis of fit to principles derived from the World Health Organization (WHO) and other definitions of sexual health. Studies (n=20) were drawn from Medline and PsycINFO databases (English language, adult populations, 1996-2011) and fell into three domains: knowledge, attitudes, and sexual behaviors. We estimated intervention effects via Hedges' g, using the random-effects approach. Initial estimates revealed a large effect for knowledge, g=1.32 (95% CI=0.51-2.14), and smaller effects for attitude change, g=0.17 (0.11-0.24) and behavior, g=0.21 (0.13-0.29). After removing outliers to produce more precise estimates, the final effect sizes for knowledge, attitudes, and sexual behavior were, respectively, 0.25 (0.03-0.48), 0.18 (0.12-0.24), and 0.18 (0.11-0.24). Interventions yielded positive effects across populations and in all the domains studied.

It's Your Game-Tech: Toward Sexual Health in the Digital Age

Adolescent sexually transmitted infection (STI) and birth rates indicate a need for effective middle school HIV/STI, and pregnancy prevention curricula to delay, or mitigate consequences of, early sexual activity. Individual and organizational barriers to adoption, implementation, and maintenance, however, can hamper dissemination of evidence-based sexual health curricula, adversely impacting fidelity and reach. Internet-based approaches may help mitigate these barriers. This paper describes the development and feasibility testing of It's Your Game (IYG)-Tech, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing effective sexual health curriculum-It's Your Game… Keep it Real (IYG). IYG-Tech development adaptation steps were to: 1) Select a suitable effective program and gather the original program materials; 2) Develop "proof of concept" lessons and test usability and impact; 3) Develop the program design document describing the core content, scope, and methods and strategies; and 4) produce the new program. Lab- and school-based tests with middle school students demonstrated high ratings on usability parameters and immediate impact on selected psychosocial factors related to sexual behavior-perceptions of friends' beliefs, reasons for not having sex, condom use self-efficacy, abstinence intentions, negotiating with others to protect personal rules, and improved knowledge about what constitutes healthy relationships (all p < .05). Youth rated IYG-Tech is favorably compared to other learning channels (>76.2% agreement) and rated the lessons as helpful in making healthy choices, selecting personal rules, detecting challenges to those rules, and protecting personal rules through negotiation and refusal skills (89.5% - 100%). Further efficacy testing is indicated for IYG-Tech as a potential strategy to deliver effective HIV/STI, and pregnancy prevention to middle school youth.

Feasibility of delivering evidence-based HIV/STI prevention programming to a community sample of African American teen girls via the internet

The current study examined the feasibility of an HIV/STI prevention intervention for African American female adolescents. The intervention SiHLEWeb is a web-based adaptation of the evidence-based intervention, Sistas, Informing, Healing, Living, and Empowering (SiHLE). Participants were 41 African American girls aged 13 to 18 years, recruited in collaboration with community partners (local high schools, Department of Juvenile Justice, child advocacy center, medical university). Results support the feasibility of recruitment, screening, and follow-up retention methods. The majority (63.4%) of recruited participants completed the intervention, taking an average of 4.5 (SD = 3.63) site visits. Completers of SiHLEWeb demonstrated increases in knowledge regarding HIV/STI risks and risk reduction behavior [t(18) = 4.74, p < .001], as well as significant increases in condom use self-efficacy [t(16) = 2.41, p = .03]. Findings provide preliminary support for the large-scale, randomized-controlled trial of the efficacy of SiHLEWeb to reduce high-risk sexual behavior among female African American adolescents.

Update and expansion of the HIV/AIDS prevention program archive (HAPPA)

Established in 1996 with funding from CDC and NIH, the HIV/AIDS Prevention Program Archive (HAPPA) is now the biggest private sector collection of HIV-related evidence-based behavioral interventions (EBIs). Each EBI in HAPPA has been determined by a distinguished Scientist Expert Panel to have demonstrated efficacy in preventing HIV or its risk-related behaviors in the United States. The multimedia replications kits contain everything that a new site would need to implement an EBI such as a user guide that gives an overview of the program and the evidence of its effectiveness; a facilitator's manual that gives step-by-step implementation protocols for each session; and session implementation materials referenced in the facilitator's manual such as slides, video clips, participant handouts, activity masters, checklists, and homework assignments for the next session. The program packages also contain evaluation materials such as surveys and questionnaires that were used in the original demonstration of effectiveness and that may be used to re-evaluate the program as implemented in a new setting. Recently, we have expanded HAPPA's scope to include HIV EBIs developed globally and to include evidence-based structural interventions (effective in modifying the physical, social, cultural, political, economic, legal, and/or policy aspects of the HIV risk environment). This paper describes HAPPA's procedures for identifying, selecting, acquiring and packaging HIV EBIs. It also provides comprehensive lists of evidence-based HIV behavioral and structural interventions and gives information on how to access EBI program packages for implementation in new settings.

Evaluation of an HIV prevention intervention designed for African American Women: results from the SISTA Community-Based Organization Behavioral Outcomes Project

One of the Centers for Disease Control and Prevention's strategies for addressing racial disparities within the HIV epidemic is to support the implementation of HIV prevention behavioral interventions designed for African Americans. One such intervention is Sisters Informing Sisters about Topics on AIDS (SISTA), a culturally relevant and gender-specific, five-session, group-level, HIV prevention intervention designed for African American women. In 2008, the Centers for Disease Control and Prevention funded five community-based organizations to conduct outcome monitoring of SISTA to assess the outcomes associated with implementation in the field. Using a 90-day recall, demographic and sexual risk data were collected from participants at baseline and at 90 and 180 days post-intervention. Findings reveal that women participating in SISTA (n = 432) demonstrated a significant reduction in sexual risk between baseline and both follow-up time points for each of the six outcomes being measured (e.g., any unprotected sex, all protected sex).

Streaming weekly soap opera video episodes to smartphones in a randomized controlled trial to reduce HIV risk in young urban African American/black women

Love, Sex, and Choices is a 12-episode soap opera video series created as an intervention to reduce HIV sex risk. The effect on women's HIV risk behavior was evaluated in a randomized controlled trial in 238 high risk, predominately African American young adult women in the urban Northeast. To facilitate on-demand access and privacy, the episodes were streamed to study-provided smartphones. Here, we discuss the development of a mobile platform to deliver the 12-weekly video episodes or weekly HIV risk reduction written messages to smartphones, including; the technical requirements, development, and evaluation. Popularity of the smartphone and use of the Internet for multimedia offer a new channel to address health disparities in traditionally underserved populations. This is the first study to report on streaming a serialized video-based intervention to a smartphone. The approach described here may provide useful insights in assessing advantages and disadvantages of smartphones to implement a video-based intervention.