Enhancing maintenance of HIV intervention efficacy by brief, telephone-delivered, tailored counseling for young African American women

Background: Behavioral interventions have demonstrated efficacy in reducing HIV-associated risk behaviors and sexually transmitted infections. Unfortunately, over time, intervention effects rapidly deteriorate. We tested a novel maintenance strategy, brief cellphone-delivered counseling, designed to sustain effects of a behavioral intervention. Methods: From June 2005 to June 2007 young African American women (N=701), 14-20 years, recruited from three clinics in Atlanta, Georgia enrolled in the study, completed baseline assessments and provided written informed consent. Baseline data collection consists of an ACSAI assessment and specimens for detection of Chlamydia. Following baseline, participants were randomized to: (1) the maintenance condition, or (2) a time-equivalent comparison condition. Participants in both the maintenance and comparison conditions completed one 5-hour group-formatted HIV prevention session. Subsequently, participants in the maintenance condition received bi-monthly, individually tailored, cellphone-delivered HIV prevention counseling while participants in the comparison condition received dose-equivalent cellphone-delivered nutrition counseling. Participants completed assessments at 6-, 12- and 18-months post-baseline. Growth curve modeling examined condition effects over time. Results: Relative to baseline, both conditions showed significant shortterm effects (12 months). However, statistically significant differences were observed at 18-month assessment: the maintenance condition had lower Chlamydia incidence (6.6% vs 14.2%; P=.005), lower mean frequency of sex while high on drugs/ alcohol (1.38 vs 2.79; P=.001), and a higher mean percent condom-protected sex acts (56.5% vs 49.7%; P=.05). Conclusions: Brief cellphone-delivered HIV prevention counseling is an effective strategy sustaining intervention effects. This strategy may be particularly efficient and cost-effective in intervening with hard-to-access populations.