Designing Evidence-Based HIV/STD Interventions for African American Youth

Transcription

1 Toronto I-II 11:45 am Designing Evidence-Based HIV/STD Interventions for African American Youth Loretta Jemmott van AmeringenProfessor in Psychiatric Mental Health Nursing, Director of the Center for Health Disparities Research, University of Pennsylvania School of Nursing, and National Institutes of Health grant recipient for Barbershop-based HIV/STD Risk Reduction for African American Young Men Fanta Ongoiba Executive Director of Africans in Partnership Against AIDSandan active leader in HIV/AIDS support, education and research in the African, Caribbean and Black communities in Canada

2 Doing What Works! Designing Evidence-Based HIV/STD Interventions for African American Youth OHTN 2013 Annual Research Conference Changing The Course on the HIV Prevention, Engagement and Treatment Cascade Loretta Sweet Jemmott, Ph.D., RN., FAAN van Ameringen Professor in Psychiatric Mental Health Nursing University of Pennsylvania - School of Nursing 2

3 A Program of Research That Seeks To: Elucidate the social and psychological factors that underlie HIV/STD and risk-associated sexual behavior (.Listen to their voices). Identify the particular conceptual variables that are most important to achieving intervention-induced sexual behavior change. Identify theory-based, culture-sensitive, developmentally appropriate strategies to reduce HIV/STD and riskassociated sexual behaviors

4 A Program of Research That Seeks To: (cont d) Answer practical questions about the most effective way to implement HIV/STD and risk-reduction interventions with ethnic minority youth Test the effectiveness of such interventions using scientifically rigorous methodologies and experimental designs Tailor and disseminate effective research-based behavioral interventions to nongovernmental organizations, schools, churches, clinics, etc

5 CO-INVESTIGATORS John B. Jemmott III, Ph.D. Annenberg School of Communication M. Kathy Hutchinson, PhD, RN School of Nursing Larry Icard, Ph.D. School of Social Administration Ann O Leary, Ph.D. Center for Disease Control and Prevention David Metzger, Ph.D. Department of Psychiatry - Center for Studies Addiction Erica Gollub, Ph.D. Department of Psychiatry - Center for Studies Addiction Funded by: The National Institute of Health The American Foundation for AIDS Research (AmFAR) The Center for Disease Control and Prevention (CDC)

6 HOW DO WE CONDUCT OUR RESEARCH?

7 Six Phases of Intervention Development Research Elicitation (Focus Groups Code of the Street Hearing Their Voices) Questionnaire Development Design Culturally Appropriate Intervention Pilot Test the Intervention Evaluation Dissemination 7/20/08 7

8 Thinking!!! What are the questions?? What are the good things about practicing abstinence? What are the bad things about it? What s easy about about it? What s hard about it? Who is supportive it? Who is not supportive it? What about using condoms? (use same series of questions) 7/20/08 8

9 THEORETICAL MODELS Social Cognitive Theory Self-efficacy, Outcome Expectancy, (Hedonistic, Partner Reaction, Prevention Beliefs) and Skills. Theory of Reasoned Action Attitudes, Beliefs, Subjective Norms and Intentions. Theory of Planned Behavior Perceived Behavioral Control and Control Beliefs

10 THEMES: (FAMILY, COMMUNITY, CULTURE & PRIDE) Respect Yourself, Protect Yourself...Because You Are Worth It Let s Work Together to Save Our People & Community. Be Proud, Be Responsible...Respect Yourself, Protect Yourself!

11 Revise ideas, papers, and strategies and again and again and again 11

12 Plan a follow-up evaluation of the outcomes of my ideas 12

13 WHAT DO OUR INTERVENTIONS INVOLVE? Small Group Discussion Culturally Appropriate Themes & Strategies Developmentally Appropriate Strategies Interactive Activities Audiovisuals Knowledge Self-efficacy Attitudes/Beliefs Goals & Dreams Technical Skill Building Role Playing Practice and Feedback

14 JEMMOTT, JEMMOTT, & FONG (1992, AJPH)--DESIGN Randomized controlled trial 157 African American male adolescents at a weekend program Mean age was 14.6 years 83% reported ever having sexual intercourse Five hour cognitivebehavioral small group intervention Facilitator gender 96% 3-month follow-up return rate

15 JEMMOTT, JEMMOTT, & FONG (1992, AJPH)--RESULTS Reduced HIV/STD and risk-associated sexual behavior Reduced frequency of sexual intercourse Reduced unprotected sexual intercourse Fewer sexual partners No consistent effect of gender of facilitator Self-reported sexual behavior change unrelated to social desirability bias

16 THE JEMMOTT INTERVENTION BE PROUD! BE RESPONSBILE

17 JEMMOTT, JEMMOTT, FONG & MCCAFFREE (1999 AJCP) --DESIGN Randomized controlled trial 496 African American adolescents at a weekend program Mean age was 13.1 years 54% were female 55% reported ever having sexual intercourse 5-hour cognitive-behavioral small group intervention Facilitator race, facilitator gender, and group gender composition 96% 3-month follow-up return rate; 93% 6-month follow-up return rate

18 JEMMOTT, JEMMOTT, FONG & MCCAFFREE (1999 AJCP) --RESULTS Reduced HIV/STD and risk-associated sexual behavior Reduced unprotected sexual intercourse Self-reported sexual behavior change unrelated to social desirability bias Intervention effects were the same irrespective of race of facilitator, gender of facilitator, and the gender composition of the group

19 HIV Prevention Programs for Latino Youth (FUNDED BY NINR) CUIDATE! VILLARRUEL, JEMMOTT & JEMMOTT 19

20 Be Proud! Be Responsible! Carribbean Style A HIV Prevention Program for Afro-Caribbean Youth In Miami Florida 20

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22 Which risk reduction messages are most effective with adolescents, abstinence of safer sex? Which types of individuals are likely to be the most effective in delivering those messages, peers or adults?

23 JEMMOTT, JEMMOTT, & FONG (1998, JAMA)--DESIGN Randomized controlled trial 659 African American adolescents at a weekend program Mean age was 11.8 years 53% were female 8-hour abstinence-based, safer-sex, or general health promotion intervention Adult facilitator or peer co-facilitators 96% 3-month follow-up return rate 25% reported ever having sexual intercourse

24 JEMMOTT, JEMMOTT, & FONG (1998, JAMA)-- RESULTS Abstinence intervention reduced the frequency of coitus and, in virgins, delayed initiation of coitus. Safer-sex intervention increased condom use. Safer-sex intervention reduced unprotected coitus. Adult and peer facilitators equally effective. Self-reported sexual behavior change unrelated to social desirability bias.

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26 The Promoting Health Among Teens (PHAT) Project: Objectives Test of the efficacy of HIV/STD risk reduction interventions. Evaluate a strategy to increase the longterm efficacy of HIV/STD risk reduction interventions. 26

27 THE LATEST NEWS EFFECTS OF OUR ABSTIENCE INTERVENTION STUDY. 24-MONTHS LATER

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29 Clinical Level Interventions: Partnered With Nurses and Health Educators to Implement Interventions in Primary Care Clinical Settings

30 SISTERS SAVING SISTERS: THE ADOLESCENT FEMALE HEALTH PROMOTION PROJECT Is skills practice necessary to achieve behavior change? Can behavioral interventions reduce STD incidence among adolescents women? (used bio-specimen collection along with questionnaires) 30

31 SISTER TO SISTER: THE BLACK YOUNG WOMEN HEALTH PROMOTION PROJECT What type of HIV risk reduction intervention is best for African American women in a primary care setting? Group vs. Individual? Information alone vs. Skill based? Can a single session, 20 minute 1-on-1 skill-based intervention reduce HIV riskassociated sexual behavior and the incidence of STDs? 31

32 Did It Work? Was it effective in changing behavior? Did it reduce STD incidence?

33 Why Do Our Interventions Work? Teach skills Emphasize hedonistic beliefs Hold their attention Very interactive and fun Nonjudgmental, caring, and supportive Culturally sensitive Developed based on hearing their voices and the context of their lives Videos are appropriate Excellent teacher-student interaction Age specific Good discussions Credible Use culturally appropriate strategies (ie.., storytelling) Promote confidence Build pride/responsibility

34 Translating Sister to Sister Into Clinical Practice Sites

35 Dissemination and Translation of Sister to Sister CDC selected Sister to Sister for replication, dissemination and translation to clinics in its program entitled, Replication of Evidenced-Based Projects. CDC funded us to examine the feasibility of translating and tailoring this intervention for nurses to implement in various Family Planning Clinics.

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37 Adapting Sister to Sister For HIV+ Women

38 Recently. The Newly Created Office of Adolescent Health, Office of Public Health and Science, The U.S. Department of Health and Human Services Created RFA for Teenage Pregnancy Prevention: Replication of Evidenced Based Programs For a total of $110,000,000.

39 Tier 1 Funding was $75,000,000 to fund the replication of programs that have been proven effective through rigorous evaluation to reduce teenage pregnancy behavior risk factors Tier 2 Funding was $25,000,000 to fund the research to develop, replicate, refine, and test additional models and innovation strategies for preventing teenage Pregnancy They listed 20 evidenced-based programs for grantees to use and 8 of the 20 were mine Results: 35 states across the nation were funded to use one of my curricula in their schools, clinics, or CBOs

40 Effective Programs Be Proud! Be Responsible! Be Proud! Be Responsible! Be Protected! Making Proud Choices! Making A Difference! Sister to Sister! Cuidate! Sisters Saving Sisters Promoting Health Among Teens

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42 Building Capacity Build Capacity and New Partnerships to Design Culturally Competent, Collaborative, Compassionate Strategies to Reduce HIV Risk Behaviors to save lives 42

43 HOW DO WE DISSEMINATE INFORMATION TO TEENS NATIONALLY?

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46 New HIV Risk Reduction Intervention Outcomes. Adolescent Interventions: Parents and Teens

47 MOTHERS AND SONS HEALTH PROMOTION PROJECT in 42 HOUSING DEVELOPMENTS Trained Housing Development Community Leaders to Train and Empower Single Mothers To Reduce HIV /STD Risk Behaviors Among Their Sons Building on Their Strengths!

48 CHURCH & FAMILY HEALTH PROMOTION PROGRAM Trained and Empowered 15 Churches to Reduce HIV /STD Risk Behavior Among Their Members and Their Community Focusing on Abstinence TOGETHER WE CAN DO ALL THINGS

49 Adolescents in South Africa, Botswana & Jamaica

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51 Building Capacity Build Capacity and New Partnerships to Design Culturally Competent, Collaborative, Compassionate Strategies to Reduce HIV Risk Behaviors to save lives 51

52 Other Projects. The BRO Project for HIV+ African American MSM EBAN Project for African American Serodiscordant Couples HIVPOS for African American HIV positive men Mobile Phone project for youngmafrican American MSM ages 18-24

53 What Am I Working On Now?

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60 THANK YOU 60

61 What s next? 12:15 p.m Lunch Jay Browne Award