Well Woman Program: A community-based STI prevention trial

Background: Sexually transmitted infections (STIs) represent an epidemic in the United States, an unparalleled source of dire health consequences disproportionately affecting African American women. Few STI behavioral intervention studies, using laboratory-confirmed STIs as outcome measures, have been designed specifically for African American women.

Purpose: The purpose of this study was to test the efficacy of the Well Woman Program (WWP), a case-managed, nurse practitioner (NP)-delivered culturally specific intervention, designed to lower STI rates among African-American women with a history of repeated STIs.

Methods: In this 2-group randomized clinical trial, 342 low-income African American women were randomly assigned to the WWP or a minimal intervention (MI) group. The primary outcome, biologically confirmed STIs, and several covariates were measured at baseline and 3 additional time points. Results: At baseline, approximately 75% of participants tested positive for a STI. In the final random effects logistic regression model, compared to the MI group, the estimated probability of WWP participants contracting an STI declined over time at a steeper rate. At month 15, the probability of a WWP participant contracting an STI was 20% less than that of a MI participant.

Conclusions: Although both interventions were clearly effective in reducing STIs, the WWP NP care delivery model that incorporated individualized tailoring and group targeting to develop knowledge, will, and skill led to a decrease in STIs that was sustained.