title: HIV/STI risk-reduction intervention efficacy with South African adolescents over 54 months.
abstract: OBJECTIVE
  Little research has tested HIV/sexually transmitted infection (STI) risk-reduction interventions' effects on early adolescents as they age into middle and late adolescence. This study tested whether intervention-induced reductions in unprotected intercourse during a 12-month period endured over a 54-month period and whether the intervention reduced the prevalence of STIs, which increase risk for HIV.
  
  
  METHODS
  Grade 6 learners (mean age = 12.4 years) participated in a 12-month trial in Eastern Cape Province, South Africa, in which 9 matched pairs of schools were randomly selected and within pairs randomized to a theory-based HIV/STI risk-reduction intervention or an attention-control intervention. They completed 42- and 54-month postintervention measures of unprotected intercourse (the primary outcome), other sexual behaviors, theoretical constructs, and, at 42- and 54-month follow-up only, biologically confirmed curable STIs (chlamydial infection, gonorrhea, and trichomoniasis) and herpes simplex virus 2.
  
  
  RESULTS
  The HIV/STI risk-reduction intervention reduced unprotected intercourse averaged over the entire follow-up period (OR = 0.42, 95% CI [0.22, 0.84]), an effect not significantly reduced at 42- and 54-month follow-up compared with 3-, 6-, and 12-month follow-ups. The intervention caused positive changes on theoretical constructs averaged over the 5 follow-ups, although most effects weakened at long-term follow-up. Although the intervention's main effect on STIs was nonsignificant, an Intervention Condition × Time interaction revealed that it significantly reduced curable STIs at 42-month follow-up in adolescents who reported sexual experience.
  
  
  CONCLUSIONS
  These results suggest that theory-based behavioral interventions with early adolescents can have long-lived effects in the context of a generalized severe HIV epidemic.
authors.affiliation: Annenberg School for Communication, University of Pennsylvania.
authors.forename: John B
authors.initials: JB
authors.lastname: Jemmott
authors.affiliation: School of Nursing, University of Pennsylvania.
authors.forename: Loretta S
authors.initials: LS
authors.lastname: Jemmott
authors.affiliation: Centers for Disease Control and Prevention.
authors.forename: Ann
authors.initials: A
authors.lastname: O'Leary
authors.affiliation: Department of Anthropology, Haverford College.
authors.forename: Zolani
authors.initials: Z
authors.lastname: Ngwane
authors.affiliation: National Institute for Communicable Diseases.
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania.
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.affiliation: College of Health Professions and Social Work, Temple University.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Icard
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania.
authors.forename: Craig
authors.initials: C
authors.lastname: Carty
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania.
authors.forename: G Anita
authors.initials: GA
authors.lastname: Heeren
authors.affiliation: Department of Statistics, University of Fort Hare.
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Tyler
authors.affiliation: Human Resources Research Council.
authors.forename: Monde B
authors.initials: MB
authors.lastname: Makiwane
authors.affiliation: School of Nursing, University of Pennsylvania.
authors.forename: Anne
authors.initials: A
authors.lastname: Teitelman
mesh_terms: D000293:Adolescent; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006293:Health Promotion / Q000592:standards*; D006801:Humans; D008297:Male; D008403:Mass Screening; D040242:Risk Reduction Behavior; D012725:Sexual Behavior / Q000523:psychology; D013019:South Africa; D055815:Young Adult
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