A cluster randomized controlled trial of an adolescent HIV prevention program among Bahamian youth: effect at 12 months post-intervention

Abstract

Behavioral interventions based on the Protection Motivation Theory (PMT) have been demonstrated to reduce HIV risk behavior among mid- and older adolescents in different settings across the globe but have not been evaluated among Caribbean nations and have received limited evaluation among pre-adolescents. To determine (1) the effectiveness among pre-adolescents in The Bahamas of a PMT-based HIV prevention program "Focus on Youth in the Caribbean" (FOYC) and (2) the role of the targeted PMT constructs in intervention effect. 1,360 sixth grade youth (10-11 years of age) from 15 urban schools in New Providence, The Bahamas were randomized by school to receive either FOYC or a control condition. Data collected at baseline, 6 and 12 months post intervention were analyzed. A five-step scheme was used to assess sexual behavior progression, ranging from "1" = "a virgin without intention to have sex" to "5" = "having sex without a condom". Group-based trajectory analysis was utilized in assessing the program effect. Two sexual behavior progression patterns were detected: slow progressors and quick progressors. Receiving FOYC reduced the likelihood for adolescents to become quick progressors (adjusted OR = 0.77, 95% CI: 0.64-1.00). The observed effectiveness was especially impacted by a subset of the targeted PMT constructs. FOYC effectively delays sexual risk among Bahamian pre-adolescents. The group-based trajectory analysis provides an analytical approach for assessing interventions among adolescents with low rates and diverse progression patterns of sexual activity.

Figures

Figure 1

Cognitive processes involved in decision making in the Protection Motivation Theory. Two pathways lead to the intention to be involved in a HIV risk or protective behavior (see text for further description)

Figure 2

Consolidated Standards of Reporting Trials (CONSORT) –Style Diagram Illustrating the Selection, Randomization and Evaluation of the Intervention

Figure 3

Differences in Sexual Behaivor Progression between the Intervention (FOYC, N=863) and Control (WW, N=497), Bahamian Adolescents, 2007 Note: Progression index: 1 = no intention to have sex, 2 = likely to have sex in the next 6 months, 3 = sexual debut, 4= always used a condom during sex and 5 = did not always use a condom during sex.

1. Progression score (slow, FOYC) = 0.3836 + 0.0670(age)

2. Progression score (quick, FOYC) = −59.1194 + 10.5797(age) − 0.4484 (age)2

3. Progression score (slow, WW) = 0.7339 + 0.0647(age)

4. Progression score (quick, WW) = −32.5182 + 5.7380(age) − 0.2302(age)2