Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN Dean College of Nursing

1. Lessons Learned from Conducting a Community-based HIV Prevention RCT with Urban Adolescent Girls Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN Dean College of Nursing Senior Associate Vice President USF Health Professor of Nursing and Public Health

2. University of South Florida – College of NursingTampa, Florida National Institute of Health/National Institute of Nursing Research (R01 NR008194).

3. Introduction Finding innovative approaches to unique challenges encountered with sexual risk-reduction interventions in RCTs conducted in urban settings with adolescent girls.

4. Problem: HIV in Adolescent Girls 72% of new HIV infections in adolescents result from unprotected sexual contact; 89% in females. 19 million STI cases annually: Adolescent girls higher rates of GC and CT than similarly aged males or older persons of either gender. Unintended pregnancy rates increasing in older adolescents 39% of sexually active youth report no condom use during last sexual intercourse

5. Adolescence: Window of Opportunity Studies in countries with generalized AIDS epidemics show that women become infected at younger ages than men, usually by older men. Men’s infections tend to occur at later ages.

6. Health Improvement Project for Teens (HIPTeens) SRR 4 Sessions Reunion Reunion Data Enroll* R CTL 4 Sessions Reunion Reunion Data Pre 1 wk post 3 mo post 6 mopost 12 mopost ACASI Data Points: *N=738, ages 15-19

7. Purpose Evaluate a RCT gender-specific sexual risk-reduction intervention, targeting low-income, urban, sexually active adolescent girls.

8. Recruitment Sites Clinical adolescent health centers Youth development programs providing services of economically disadvantaged Family planning agencies Health fairs and local high schools Included use of posters, self-referral, and friend-referral

9. Baseline Data Participants’ age and risk behaviors

10. Results • HIPTEENS participants showed statistically significan changes in: • Fewer episodes of vaginal sex at all follow-ups • Fewer episodes of unprotected vaginal sex at 3 and 12 month follow-ups • Decrease in total number of partners at 6 month follow-up • Higher rates of abstinence at 3 and 12 month follow-ups • Medical record audits documented 50% reduction in positive pregnancy tests at 12-months

11. Challenges • A number of challenges threatened intervention integrity: • Complexities of Urban setting • Psychosocial complexities of participants • Topic area (sexual risk reduction) • Research Team

12. Complexities of Urban Setting • Safety Issues • Weapons • Gang involvement • External intrusions/disruptions • Protestors • Male partners

13. Participant Psychosocial Complexities • Developmental Stage • Adolescents reason differently from adults • Low future time perspective influences actions • Social Issues • Food Insecurity/Hunger • Income generating schemes • Unstable housing

14. Topic Area • Discussion of Sex • Opens Pandora’s box • Reconcile with participant’s other info sources • Media Impact • Music • Movies • Media

15. Research Team • Length of recruiter employment • Greater retention • Retention of staff over multiple years • Intervention Facilitator Characteristics • Age important • Capacity Building • Dress Code • Intervention Fidelity/Integrity • Intellectual Property Infringement

16. What Did we Learn? • RCT embedded within an RCL • Rocky Circumstances of Life • Social issues not evenly distributed • Disparities among African Americans • Adolescents more vulnerable than adults • Anticipate and accommodate needs • Highest risk groups likely to have high needs • Will impact translatability to practice

17. Out of the Box Thinking • Conducting RCTs with adolescents in urban communities requires “Out of the Box” thinking to anticipate and address challenges to intervention implementation

18. Implementation Workshop