Sustainability of intervention effects of a woman-focused HIV prevention intervention for African American crack-using women

Background: HIV intervention evaluations often only assess efficacy in the short term. We conducted a long-term evaluation of a woman-focused (WF) HIV intervention for African American crack cocaine smokers for which we had previously observed beneficial short-term gains.

Methods: 446 out-of-treatment African American women who use crack cocaine participated in a randomized field experiment and were followed up to determine sustainability of intervention effects across three conditions: the WF intervention, a modified standard NIDA intervention, and a control condition. Latent class analyses were conducted to compare the three groups in terms of HIV risk behavior at short term (STFU; 3-6 months) and long term (LTFU; over 24 months) follow-up.

Results: Latent class analyses revealed two distinct groups at STFU, those who either eliminated or greatly reduced their risk behaviors (low-risk class) and those who retained high levels of risk across multiple risk domains. At STFU, women in the WF intervention were more likely to be in the low HIV risk group than the women in control conditions, but this effect was not statistically significant at LTFU. However, low-risk participants at STFU were less likely to be retained at LTFU, and this retention rate was lowest among those in WF intervention.

Conclusions: As long-term retention was lower among women who had successfully reduced their risk in short-term, we cannot know whether there was sustained reductions in risk in the long-term. Yet, the evidence indicates that retention is highest among those who are in most need for long-term booster sessions.