title: Comparative Effectiveness of Web-Based vs. Educator-Delivered HIV Prevention for Adolescent Substance Users: A Randomized, Controlled Trial.
abstract: BACKGROUND
  Young people who engage in substance use are at risk for becoming infected with HIV and diseases with similar transmission dynamics. Effective disease prevention programs delivered by prevention specialists exist but are rarely provided in systems of care due to staffing/resource constraints and operational barriers-and are thus of limited reach. Web-based prevention interventions could possibly offer an effective alternative to prevention specialist-delivered interventions and may enable widespread, cost-effective access to evidence-based prevention programming. Previous research has shown the HIV/disease prevention program within the Web-based therapeutic education system (TES) to be an effective adjunct to a prevention specialist-delivered intervention. The present study was the first randomized, clinical trial to evaluate the comparative effectiveness of this Web-based intervention as a standalone intervention relative to a traditional, prevention specialist-delivered intervention.
  
  
  METHODS
  Adolescents entering outpatient treatment for substance use participated in this multi-site trial. Participants were randomly assigned to either a traditional intervention delivered by a prevention specialist (n=72) or the Web-delivered TES intervention (n=69). Intervention effectiveness was assessed by evaluating changes in participants' knowledge about HIV, hepatitis, and sexually transmitted infections, intentions to engage in safer sex, sex-related risk behavior, self-efficacy to use condoms, and condom use skills.
  
  
  RESULTS
  Participants in the TES intervention achieved significant and comparable increases in HIV/disease-related knowledge, condom use self-efficacy, and condom use skills and comparable decreases in HIV risk behavior relative to participants who received the intervention delivered by a prevention specialist. Participants rated TES as easier to understand.
  
  
  CONCLUSIONS
  This study indicates that TES is as effective as HIV/disease prevention delivered by a prevention specialist. Because technology-based interventions such as TES have high fidelity, are inexpensive and scalable, and can be implemented in a wide variety of settings, they have the potential to greatly increase access to effective prevention programming.
authors: Dartmouth College, Geisel School of Medicine, Department of Psychiatry, Center for Technology and Behavioral Health, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766. Electronic address: Lisa.A.Marsch@Dartmouth.edu.
authors: Lisa A
authors: LA
authors: Marsch
authors: National Development and Research Institutes, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010.
authors: Honoria
authors: H
authors: Guarino
authors: Red 5 Group, LLC, 101 West 23rd Street, New York, NY 10011.
authors: Michael J
authors: MJ
authors: Grabinski
authors: National Development and Research Institutes, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010.
authors: Cassandra
authors: C
authors: Syckes
authors: National Development and Research Institutes, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010.
authors: Elaine T
authors: ET
authors: Dillingham
authors: Dartmouth College, Geisel School of Medicine, Department of Psychiatry, Center for Technology and Behavioral Health, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766.
authors: Haiyi
authors: H
authors: Xie
authors: Dartmouth College, Geisel School of Medicine, Department of Psychiatry, Center for Technology and Behavioral Health, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766.
authors: Benjamin S
authors: BS
authors: Crosier
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D017280:Condoms; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D008297:Male; D012309:Risk-Taking; D021841:Safe Sex; D019966:Substance-Related Disorders / Q000628:therapy*; D016896:Treatment Outcome
keywords: Adolescents; HIV; Prevention; Substance use