title: Adolescent abstinence and unprotected sex in CyberSenga, an Internet-based HIV prevention program: randomized clinical trial of efficacy.
abstract: BACKGROUND
  Cost-effective, scalable programs are urgently needed in countries deeply affected by HIV.
  
  
  METHODS
  This parallel-group RCT was conducted in four secondary schools in Mbarara, Uganda. Participants were 12 years and older, reported past-year computer or Internet use, and provided informed caregiver permission and youth assent. The intervention, CyberSenga, was a five-hour online healthy sexuality program. Half of the intervention group was further randomized to receive a booster at four-months post-intervention. The control arm received 'treatment as usual' (i.e., school-delivered sexuality programming). The main outcome measures were: 1) condom use and 2) abstinence in the past three months at six-months' post-intervention. Secondary outcomes were: 1) condom use and 2) abstinence at three-month's post-intervention; and 6-month outcomes by booster exposure. Analyses were intention to treat.
  
  
  RESULTS
  All 416 eligible youth were invited to participate, 88% (n = 366) of whom enrolled. Participants were randomized to the intervention (n = 183) or control (n = 183) arm; 91 intervention participants were further randomized to the booster. No statistically significant results were noted among the main outcomes. Among the secondary outcomes: At three-month follow-up, trends suggested that intervention participants (81%) were more likely to be abstinent than control participants (74%; p = 0.08), and this was particularly true among youth who were abstinent at baseline (88% vs. 77%; p = 0.02). At six-month follow-up, those in the booster group (80%) reported higher rates of abstinence than youth in the intervention, no booster (57%) and control (55%) groups (p = 0.15); they also reported lower rates of unprotected sex (5%) compared to youth in the intervention, no booster (24%) and control (21%) groups (p = 0.21) among youth sexually active at baseline.
  
  
  CONCLUSIONS
  The CyberSenga program may affect HIV preventive behavior among abstinent youth in the short term and, with the booster, may also promote HIV preventive behavior among sexually active youth in the longer term.
  
  
  BACKGROUND
  NCT00906178.
authors: Center for Innovative Public Health Research, San Clemente, California, United States of America. Michele@InnovativePublicHealth.org
authors: Michele L
authors: ML
authors: Ybarra
authors: Sheana S
authors: SS
authors: Bull
authors: Tonya L
authors: TL
authors: Prescott
authors: Josephine D
authors: JD
authors: Korchmaros
authors: David R
authors: DR
authors: Bangsberg
authors: Julius P
authors: JP
authors: Kiwanuka
mesh_terms: D000293:Adolescent; D002648:Child; D003140:Communicable Disease Control / Q000379:methods*; D017280:Condoms; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D020407:Internet; D008297:Male; D018579:Patient Selection; D012746:Sexual Abstinence; D047568:Unsafe Sex
references: AIDS Behav. 2013 Mar;17(3):1116-28
references: 22350827
references: Health Educ Res. 2011 Oct;26(5):770-81
references: 21536715
references: AIDS Behav. 2011 Nov;15(8):1732-44
references: 21380493
references: Afr J Reprod Health. 2004 Dec;8(3):55-67
references: 17348325
references: AIDS. 2000 Apr 14;14(6):756-8
references: 10807205
references: Health Psychol. 1994 May;13(3):238-50
references: 8055859
references: Am J Public Health. 2007 Jul;97(7):1241-8
references: 17538062
references: AIDS Care. 2014 Apr;26(4):441-7
references: 24093828
references: East Afr J Public Health. 2010 Mar;7(1):58-63
references: 21413574
references: Afr J Reprod Health. 2007 Dec;11(3):111-32
references: 19122794
references: Int Perspect Sex Reprod Health. 2009 Jun;35(2):82-90
references: 19620092
references: Sex Transm Infect. 2009 Apr;85 Suppl 1:i3-11
references: 19307338
references: Health Psychol. 2002 Mar;21(2):177-86
references: 11950108
references: Soc Sci Med. 2003 Jan;56(1):149-65
references: 12435558
references: Comput Inform Nurs. 2012 Nov;30(11):587-95; quiz 596-7
references: 22918136
references: Arch Sex Behav. 2003 Feb;32(1):41-53
references: 12597271
references: PLoS Med. 2006 Nov;3(11):e433
references: 17090211
references: AIDS Care. 2004 Jul;16(5):605-18
references: 15223530