Efficacy of an HIV/STI prevention intervention for incarcerated African American adolescent girls

Background: Although high rates of sexual risk and adverse sequalae among incarcerated African American girls are well recognized, no efficacious sexual risk-reduction interventions exist. This study examined the efficacy of an HIV/STI prevention intervention, IMARA, for incarcerated African American girls. IMARA is a three-session, individual-level intervention delivered over 3 months inside the facility and post-release. Methods: African American girls, 13-17 years, were recruited from youth detention to participate in an HIV/STI prevention trial. Participants (N=188) were randomized to the intervention (IMARA) or standard-of-care condition. Data were collected prior to randomization and 3- and 6-months post-baseline. At each assessment, participants completed an audio computer-assisted interview, condom skills assessment, and provided a self-collected vaginal swab specimen assayed for Chlamydia and gonorrhea. Generalized estimating equations assessed outcomes over 6-months, controlling for the baseline outcome measure and baseline differences between conditions. Results: Overall retention at each follow-up assessment was 91%, with no differences between conditions. During follow-up, IMARA participants reported higher condom use self-efficacy (p<0.001), partner communication self-efficacy (p=0.040), STI knowledge (p<0.001), condom use skills (p<0.001), and decreased depressive symptomology (p=0.042). There were no significant differences between conditions in consistent condom use, proportion of condom-protected sex acts, number of vaginal sex partners, or Chlamydia or gonorrhea incidence. Conclusions: IMARA was associated with improved mediators of HIV/STI prevention but not with changes in sexual behavior. A critical need for interventions to reduce sexual risk among incarcerated girls remains. Future interventions may benefit by also intervening with parents, social networks and/or partners of incarcerated girls.