A Cluster Randomized Controlled Trial of an Adolescent HIV Prevention Program Among Bahamian Youth: Effect at 12 Months Post-Intervention

Abstract

Behavioral interventions based on the Protection Motivation Theory (PMT) have been demonstrated to reduce HIV risk behavior among mid- and older adolescents in different settings across the globe but have not been evaluated among Caribbean nations and have received limited evaluation among pre-adolescents. To determine (1) the effectiveness among pre-adolescents in The Bahamas of a PMT-based HIV prevention program “Focus on Youth in the Caribbean” (FOYC) and (2) the role of the targeted PMT constructs in intervention effect. 1,360 sixth grade youth (10–11 years of age) from 15 urban schools in New Providence, The Bahamas were randomized by school to receive either FOYC or a control condition. Data collected at baseline, 6 and 12 months post intervention were analyzed. A five-step scheme was used to assess sexual behavior progression, ranging from “1” = “a virgin without intention to have sex” to “5” = “having sex without a condom”. Group-based trajectory analysis was utilized in assessing the program effect. Two sexual behavior progression patterns were detected: slow progressors and quick progressors. Receiving FOYC reduced the likelihood for adolescents to become quick progressors (adjusted OR = 0.77, 95% CI: 0.64–1.00). The observed effectiveness was especially impacted by a subset of the targeted PMT constructs. FOYC effectively delays sexual risk among Bahamian pre-adolescents. The group-based trajectory analysis provides an analytical approach for assessing interventions among adolescents with low rates and diverse progression patterns of sexual activity.