Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents: A randomized clinical trial

Ralph DiClemente, Gina M. Wingood, Jessica M. Sales, Jennifer L. Brown, Eve S. Rose, Teaniese L. Davis, Delia L. Lang, Angela Caliendo, James W. Hardin

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.

OBJECTIVE: To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.

DESIGN, SETTING, AND PARTICIPANTS: In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment.

INTERVENTIONS: Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health.

CONCLUSIONS AND RELEVANCE: Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling.

MAIN OUTCOMES AND MEASURES: The primary outcomeswere percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments.

RESULTS: During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95%CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95%CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95%CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95%CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95%CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = -0.61; 95%CI, -0.98 to -0.24; P < .001).

Original languageEnglish (US)
Pages (from-to)938-946
Number of pages9
JournalJAMA Pediatrics
Volume168
Issue number10
DOIs
StatePublished - Jan 1 2014

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Sexually Transmitted Diseases
Telephone
Randomized Controlled Trials
Maintenance
HIV
Infection
Odds Ratio
Condoms
Counseling
Alcohols
Coitus
Therapeutics
Risk-Taking
Pharmaceutical Preparations
African Americans
Health

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents : A randomized clinical trial. / DiClemente, Ralph; Wingood, Gina M.; Sales, Jessica M.; Brown, Jennifer L.; Rose, Eve S.; Davis, Teaniese L.; Lang, Delia L.; Caliendo, Angela; Hardin, James W.

In: JAMA Pediatrics, Vol. 168, No. 10, 01.01.2014, p. 938-946.

Research output: Contribution to journalArticle

DiClemente, Ralph ; Wingood, Gina M. ; Sales, Jessica M. ; Brown, Jennifer L. ; Rose, Eve S. ; Davis, Teaniese L. ; Lang, Delia L. ; Caliendo, Angela ; Hardin, James W. / Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents : A randomized clinical trial. In: JAMA Pediatrics. 2014 ; Vol. 168, No. 10. pp. 938-946.
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abstract = "IMPORTANCE: Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.OBJECTIVE: To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.DESIGN, SETTING, AND PARTICIPANTS: In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment.INTERVENTIONS: Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health.CONCLUSIONS AND RELEVANCE: Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling.MAIN OUTCOMES AND MEASURES: The primary outcomeswere percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments.RESULTS: During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95{\%}CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95{\%}CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95{\%}CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95{\%}CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95{\%}CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = -0.61; 95{\%}CI, -0.98 to -0.24; P < .001).",
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T1 - Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents

T2 - A randomized clinical trial

AU - DiClemente, Ralph

AU - Wingood, Gina M.

AU - Sales, Jessica M.

AU - Brown, Jennifer L.

AU - Rose, Eve S.

AU - Davis, Teaniese L.

AU - Lang, Delia L.

AU - Caliendo, Angela

AU - Hardin, James W.

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N2 - IMPORTANCE: Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.OBJECTIVE: To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.DESIGN, SETTING, AND PARTICIPANTS: In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment.INTERVENTIONS: Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health.CONCLUSIONS AND RELEVANCE: Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling.MAIN OUTCOMES AND MEASURES: The primary outcomeswere percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments.RESULTS: During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95%CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95%CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95%CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95%CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95%CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = -0.61; 95%CI, -0.98 to -0.24; P < .001).

AB - IMPORTANCE: Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.OBJECTIVE: To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.DESIGN, SETTING, AND PARTICIPANTS: In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment.INTERVENTIONS: Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health.CONCLUSIONS AND RELEVANCE: Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling.MAIN OUTCOMES AND MEASURES: The primary outcomeswere percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments.RESULTS: During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95%CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95%CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95%CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95%CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95%CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = -0.61; 95%CI, -0.98 to -0.24; P < .001).

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