ImportanceThis study is designed to address the need for evidence-based HIV/STI prevention approaches for drug-involved women under criminal justice community supervision.ObjectiveWe tested the efficacy of a group-based traditional and multimedia HIV/STI prevention intervention (Project WORTH: Women on the Road to Health) among drug-involved women under community supervision.Design, Setting, Participants, and InterventionWe randomized 306 women recruited from community supervision settings to receive either: (1) a four-session traditional group-based HIV/STI prevention intervention (traditional WORTH); (2) a four-session multimedia group-based HIV/STI prevention intervention that covered the same content as traditional WORTH but was delivered in a computerized format; or (3) a four-session group-based Wellness Promotion intervention that served as an attention control condition. The study examined whether the traditional or multimedia WORTH intervention was more efficacious in reducing risks when compared to Wellness Promotion; and whether multimedia WORTH was more efficacious in reducing risks when compared to traditional WORTH.Main Outcomes and MeasuresPrimary outcomes were assessed over the 12-month post-intervention period and included the number of unprotected sex acts, the proportion of protected sex acts, and consistent condom use. At baseline, 77% of participants reported unprotected vaginal or anal sex (n = 237) and 63% (n = 194) had multiple sex partners.ResultsWomen assigned to traditional or multimedia WORTH were significantly more likely than women assigned to the control condition to report an increase in the proportion of protected sex acts (β = 0.10; 95% CI = 0.02–0.18) and a decrease in the number of unprotected sex acts (IRR = 0.72; 95% CI = 0.57–0.90).Conclusion and RelevanceThe promising effects of traditional and multimedia WORTH on increasing condom use and high participation rates suggest that WORTH may be scaled up to redress the concentrated epidemics of HIV/STIs among drug-involved women in the criminal justice system.Trial RegistrationClinicalTrials.gov NCT01784809

Findings suggest that both modalities of WINGS show promise in identifying and addressing IPV victimisation among substance-using women receiving community supervision.

The efficacy of Computerized WORTH across multiple IPV outcomes highlights the promise of integrating computerized, self-paced IPV prevention modules in HIV prevention groups.

Highlights HEALing Communities Study is a parallel-group cluster randomized controlled trial. Communities That HEAL intervention’s goal is to reduce opioid overdose deaths. Structured consensus decision-making strategy guided study measure development. More than 80 study measure specifications and a common data model were developed. The study will provide methodology and longitudinal community data for research.

Key Points Question Is a 5-session prevention intervention for HIV and sexually transmitted infections effective in reducing sexual risk behaviors among men in a community supervision program and their main female sexual partners? Findings In this randomized clinical trial of 230 couples, participants randomized to the 5-session couple-based prevention intervention arm reported significantly fewer incidences of unprotected sex, fewer sexual partners, and fewer sexual activities with other partners compared with participants randomized to a 1-session counseling, testing, and referral program. Meaning Couple-based HIV and sexually transmitted disease prevention interventions appeared to have a substantial effect on reducing risky sexual behaviors.