Program

Nov 06, 2012

OVERVIEW

Project RESPECT is a brief, interactive counseling program for high-risk teens and adults designed to prevent sexually transmitted diseases (STDs), including HIV, through condom use.  The core content of the Project RESPECT program focuses on negotiating a behavioral plan/goal for STD risk reduction.

An experimental evaluation of two versions of Project RESPECT (one two-session version and one enhanced four-session version) among teens and young adults in public health clinics revealed positive program impacts  on STD infection, condom use, and new or casual partners (and condom use with new partners), compared with a control group.  Both versions revealed positive impacts at both 3- and 6-month follow-ups.  An experimental evaluation of a brief one-session version of Project RESPECT and a version of Project RESPECT with an additional video component among teens and young adults did not have any program impacts for Project RESPECT, but did show positive impacts on condom use at most recent sex and on condom use self-efficacy.

DESCRIPTION OF PROGRAM

Target Population: Individuals at urban health clinics being tested for STDs.

Project RESPECT is a brief counseling intervention that aims to promote HIV-risk-reduction behaviors.  The goals of the program include improving self-efficacy, attitudes, and perceived norms underlying condom use, increasing awareness of STD risk, recognizing barriers to STD risk reduction, and encouraging HIV and STD testing.

Project RESPECT has been implemented with teens using a brief, one-session protocol lasting roughly 20 minutes focusing on negotiating a behavioral plan/goal for STD risk reduction.  Project RESPECT has also been implemented with teens and young adults using a two-session protocol.  The first session is identical to the one described above, but also includes the administration of an HIV test.  The second session (also lasting 20 minutes) involves a review of the HIV test results and of the plan/goal agreed upon during the first session, as well as a brief counseling session.  Finally, Project RESPECT has been implemented as an “enhanced” four-session protocol that is based on the theory of reasoned action and social cognitive theory.  The enhanced protocol has the same first session as the aforementioned protocol.  The second, third and fourth sessions of the enhanced program last 60 minutes each and build on the goal-setting exercises of the preceding sessions.

EVALUATIONS OF PROGRAM:

Kamb, M.L., Fishbein, M., & Douglas, J.M., Rhodes, F., Rogers, J., Bolan, G., Zenilman, J., Hoxworth, T., Malotte, K., Iatesta, M., Kent, C., Lentz, A., Graziano, S., Byers, R., & Peterman, T. (1998). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial. Journal of the American Medical Association, 280(13), 1161-1167.

Evaluated Population: Heterosexual patients at inner-city health clinics (N=5,833) ages 14 and older with negative baseline HIV test results were evaluated in this study. There were more men than women, 3,269 and 2,489 respectively. Of the participants, 59 percent were black, 19 percent were Hispanic, 16 percent were white, and 6 percent were another race/ethnicity. The median age was 25 years.

Approach: Patients were randomly assigned to receive the two-session brief counseling (Arm 1), the four session enhanced counseling (Arm 2), or one two control groups (Arms 3 and 4, referred to as the “didactic messages” groups).  The didactic messages control groups received two “treatment-as-usual” clinic sessions that included two, five-minute clinician-delivered messages about HIV and STD prevention (they did not receive any interactive counseling).  All four groups encouraged consistent condom use for vaginal and anal sex with all partners and were tailored to each individual’s personal risks

The brief counseling treatment program lasted 7 to 10 days, as did each of the didactic messages controls; the enhanced counseling treatment program lasted between three and four weeks.  All four groups were interviewed at baseline and were tested for STDs.  The brief counseling group, the enhanced counseling group, and one of the didactic messages control groups then returned for follow-up appointments 3, 6, 9, and 12 months after baseline (the Arm 4 control group did not provide follow-up data).  For intervention sessions, participants were offered free condoms at every visit and $15 for each session attended after the first session.

Laboratory tests were used to identify gonorrhea, Chlamydia, syphilis, and HIV infection. Interviewers asked about self-report condom use during vaginal sex, number of sex partners, risks of sex partners, and attitudes, self-efficacy, intentions, and perceived norms regarding consistent use of condoms.

Results: At the 3-month follow-up, those in either Project SAFE treatment groups were less likely to report having multiple sex partners than those in the control group.  Among those with more than one partner, those in the two treatment groups were also less likely to report using condoms at most recent sex with their non-primary partner at the 3-month follow-up.  At the 3- and 6-month follow-ups, the two Project SAFE groups were also more likely to report that they use condoms during every vaginal intercourse in the preceding three months.   There were no significant differences between the brief and enhanced treatments on any of these measures.

Compared with the control group at the 3-month follow-up, those in the brief treatment group were less likely to report casual or new partners and, among those with a new partner, more likely to report that their partner had been tested for STDs or HIV.  On the other hand, at the 3-month follow-up, those in the enhanced Project SAFE group were more likely to report condom use at most recent sex with their primary partner (among those who reported a primary partner) and to report any condom use in the preceding three months than those in the control group and those in the brief counseling group. There were no differences in partners or reported condom use between groups at the 9- and 12-month follow-up.

At the 6- and 12-month follow-ups, individuals in both of the two counseling treatment groups were significantly less likely to have developed a new STD compared with individuals in the didactic messages control groups. There were no significant differences between the brief and enhanced treatments on this measure.  There were no differences between any groups on injection drug use.

The program was reported to be more effective for those 20 years of age and younger versus those older than 20, those who had not had a HIV test versus those reporting a test, and those who had an STD diagnosed at the enrollment visit versus those with no STD.

Roye, C., Silverman, P. P., & Krauss, B. (2007). A brief, low-cost, theory-based intervention to promote dual method use by black and Latina female adolescents: A randomized clinical trial. Health Education & Behavior, 34(4), 608-621.
Evaluated population: The evaluated population consisted of 337 sexually-active, English-speaking black (45 percent) and Latina (55 percent) females between the ages of 15 and 21 (with a mean of 18 years). The adolescents and young adults were recruited from Planned Parenthood clinics in New York City.  None of the evaluated population was currently pregnant, known to have HIV; all were currently using hormonal methods of contraception or about to start using one (34 percent were using oral contraceptives, 14 percent Depo-Provera, 4 percent Norplant, 2 percent the Lunelle injection, and 1 woman had an IUD).   The age of sexual initiation among the sample ranged from 12 to 21 years with a mean of 15.  The majority had engaged in cunnilingus (90 percent) and fellatio (78 percent); just over one-third (35 percent) had engaged in anal sex.

Approach: Four hundred study-eligible women were recruited and randomized to complete a computer-based baseline questionnaire or to not receive the questionnaire (30 percent). Women were then randomized into one of four groups: Project RESPECT intervention group (n=81), a video intervention group (n=88), a Project RESPECT + video intervention group (n=84), or a care-as-usual (control) group (n=84). Women in the Project RESPECT group received one 15-20 minute session; women in the video group watched a brief (21-minute) video that showed two black and Latino women describing the circumstances of their HIV infection and then addressing barriers to condom use.  Women in the Project RESPECT + video group saw the video first, then received the Project SAFE counseling.

All participants completed a questionnaire amended from the Project RESPECT questionnaire at 3 and 12 months after the intervention. Questionnaire topics included condom self-efficacy, types of intercourse and protected and unprotected sexual acts participated in the previous two months and types of male partners (main, casual, and new). At baseline, forty-seven percent had used a condom at most recent vaginal intercourse with their main partner and 58 percent had used a condom at most recent vaginal intercourse with a casual partner. Due to high attrition rates, only 221 women (55 percent of the original sample) participated in a 3-month follow-up and 197 women (49 percent of the original sample) participated in a 12-month follow-up.

Results: Neither the Project RESPECT treatment nor the video treatment had impacts on condom use at most recent vaginal intercourse with a main partner.  However, there was some evidence that the Project RESPECT + video treatment group was more likely to report condom use at most recent sex with a main partner than the control group at the 3-month follow-up (this was significant when using a chi-square test and marginally significant using a logistic regression).  At the 12-month follow-up there was no statistically significant evidence that women in the Project RESPECT + video intervention group were more likely to have used a condom than any other group.

Additionally, at the 3-month follow-up, women in the Project RESPECT + video intervention group were more likely to report that they could get their partner to use a condom (demonstrating positive program impacts on condom self-efficacy).  The same intervention also showed marginally significant positive impacts on condom self-efficacy at the 12-month follow-up.

Too few women reporting having a casual partner to allow for analysis of this outcome. There were no significant findings for any other outcomes.

SOURCES FOR MORE INFORMATION

References

Kamb, M.L., Fishbein, M., & Douglas, J.M., Rhodes, F., Rogers, J., Bolan, G., Zenilman, J., Hoxworth, T., Malotte, K., Iatesta, M., Kent, C., Lentz, A., Graziano, S., Byers, R., & Peterman, T. (1998). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial. Journal of the American Medical Association, 280(13), 1161-1167.

Roye, C., Silverman, P. P., & Krauss, B. (2007). A brief, low-cost, theory-based intervention to promote dual method use by black and Latina female adolescents: A randomized clinical trial. Health Education & Behavior, 34(4), 608-621.

Program information and curriculum materials available at:

http://www.cdc.gov/hiv/topics/research/respect/pdf/bcim.pdf

KEYWORDS: Adolescents (12-17); Young Adulthood (18-24); Males and Females (Co-ed); Females Only; Urban; Clinic/Provider-based; Manual is Available; Counseling/Therapy; Sexual Activity; STD/HIV/AIDS; Condom Use and Contraception

Program information last updated on 11/6/12.

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