A quarter-century of HIV prevention intervention efforts among children and adolescents across the globe

Abstract

In 1988 a group of pediatricians, developmental, clinical, child and social psychologists, anthropologists and health educators began researching in Baltimore, Maryland on an HIV prevention intervention, Focus on Youth. Over the next 25 years the questions being addressed by Focus on Youth, reflected those of the global HIV research experience. During the first phase, the questions being addressed by the broader research community included: Can HIV risk behaviors be purposefully impacted by behavioral interventions? If so, how do successful interventions differ from those that are not effective? Are theory-based interventions more likely to be effective than information-only based interventions? Can theories be translated into culturally and developmentally appropriate interventions including those that are appropriate for children and adolescents? Should parents be involved--and if so, how? During its next phase, the Focus on Youth team increasingly became concerned with a disturbing reality. A large number of interventions had been developed and some had been shown to have evidence of impact. But virtually all of these interventions had been conducted in the USA or Europe. The questions facing researchers included: With the global burden of HIV disproportionately impacting Low and Middle Income Countries (LMIC), especially those in southern Africa, the Caribbean and parts of Asia, what is known about the effectiveness of western-based interventions in these culturally, racially and economically disparate settings? With the exciting proliferation of interventions, federal agencies in the USA and international agencies including UNAIDS realized the importance of assessing the research portfolio and developing metrics of effectiveness. The questions during this phase included: What is an “effective” intervention? How are effective interventions implemented in a new setting? This phase merged with the next phase as researchers and public health workers realized that the dissemination to a new community of an intervention developed and found to be effective in one community requires change. The central questions during this time included: What changes or kinds of changes can be made to an intervention without undermining its effectiveness? What aspects of an intervention cannot be changed without potentially undermining its effectiveness? What constitutes a “change”? Who should be involved in this decision-making? These efforts culminated in our current phase, one focused on implementation. We must learn more about the factors that allow an intervention to survive and thrive and selectively target these critical factors. The main objective of this paper is to review our experiences and lessons learned in developing, implementing, and evaluating Focus on Youth in a wide range of socio-cultural settings over the past a quarter of century.

An intersectional approach for understanding the vulnerabilities of English-speaking heterosexual Caribbean youth to HIV/AIDS and sexually transmitted infections: Prevention and intervention strategies

“…Very limited research evidence demonstrated that parents exposed to skills training in the Bahamas and Trinidad and Tobago reported a number of improvements: in their HIV knowledge and attitudes toward HIV/AIDS; in conversations with their children about sexuality, sexual risks, and protective factors; and in their monitoring of their children compared to parents in the control conditions. Parenting interventions, with high “doses” of intervention and booster sessions, seem to impact children’s self-reports of their enhanced HIV knowledge, their intentions to use a condom, higher condom use, and increased feelings of self-efficacy (PAHO, 2013; Stanton and Li, 2014). However, these few studies did not have sustained interventions with parents and their children across several developmental periods from pre-adolescence, through adolescence into young adulthood, which are deemed necessary to produce credible evidence of sustained behavioral changes in both groups.…”

Efficacy of Theory-Based HIV Behavioral Prevention Among Rural-to-Urban Migrants in China: A Randomized Controlled Trial

“…Beginning in 1990, with funding from NIH, the PMT-based FOK program was developed, implemented, and evaluated in Baltimore, MD, targeting urban African American adolescents (Stanton & Li, 2014). In 1998, the U.S. Center for Disease Control and Prevention (CDC) designated FOK as one of the Programs that Work nationwide in the U.S.…”

Statistical power and sample size requirements to detect an intervention by time interaction in four‐level longitudinal cluster randomized trials

“…This study is continuing for more than 15 years funded by three separate National Institute of Health grant, and has yielded a rich data‐set resulting from multiple CRT implementations (eg, randomization is done at different levels in different NIH funded R01 based on progressive learning and implementation feasibility). The study has also resulted in multiple publications which can be found in Wang et al, 19 Li et al, 20 Stanton and Li, 21 Stanton et al, 22 and references therein. We carefully selected a section of the data that matches with the model () and assumptions made in the model.…”

“…Using the computed N 4 and the given parameters Δ, 𝛽 0 , 𝜏, 𝜌 1 = 0.5, 𝜌 2 = 0.1, and 𝜌 3 = 0.05 and 𝜉 as before we simulate Y and fit the linear mixed effect model using R "nlme" package. We follow the steps S1 to S11 as in Section 4 to compute the theoretical power ( 14) and the simulated power, only in S2 we use (21) to calculate N 4 . We present the level four sample size N 4 , theoretical power (𝜙), and simulated power ( φ) in Table 2 (additional results are in Tables 7 and 8 given in the supplementary materials), respectively for the three cost ratios.…”