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Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
HIV-positive adolescent and young adult clinic patients
Goals of Intervention
- Enhance health behaviors
- Increase condom use
- Eliminate or reduce unprotected sex
or refuse to have unsafe sex
- Eliminate or reduce drug and alcohol
use
Brief Description
TLC (Together Learning Choices,
previously referred to as Teens Linked
to Care) is a small-group
intervention designed for youth and
young adults living with HIV. TLC
consists of 2 modules: Stay Healthy
and Act Safe. The Stay Healthy
module consists of 12 sessions to
promote positive health behaviors.
Intervention sessions are focused on
coping with learning one’s seropositive
status, addressing issues of disclosure,
and helping youth to implement new daily
routines to stay healthy and actively
participate in health care decisions.
The Act Safe module
consists of 11 sessions to increase
self-protection and other-protection
motivation to change behavior and to
reduce substance use and unprotected sex
acts. HIV-positive youth identify their
risk behavior triggers and modify their
patterns of substance use as well as
increase self-efficacy of condom use and
negotiation skills. The modules are
delivered in sequence by male and female
facilitators to mixed gender groups of
HIV-positive youth. A feeling
thermometer is used in each session to
assist youth in identifying and
controlling negative emotional states.
Group discussions, role-play, video,
exercises, and goal setting encourage
the ability to effectively reach goals,
solve problems, and effectively respond
to stressful situations. |
Theoretic Basis
Intervention Duration
Stay Healthy module: 12 sessions, 2
hours each, conducted weekly over 3 month
period.
Act Safe module: 11 sessions, 2 hours
each, conducted weekly over 3 month period.
Intervention Settings
Adolescent medical care sites
Deliverer
One male and one female trained facilitator
Delivery Methods
- Exercises
- Goal Setting
- Group Discussion
- Practice
- Role play
- Video
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Intervention Package Information
An intervention package was developed with funding from CDC’s
Replicating Effective Programs (REP) Project. The intervention package and training are available through CDC’s
Diffusion of Effective Behavioral Interventions (DEBI) project.
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Evaluation Study and Results
The original evaluation of the first two
modules of TLC was conducted in Los Angeles
and San Francisco, California; New York
City, New York; and Miami, Florida between
1994 and 1996.
Key Intervention Effects
- Increased abstinence or consistent
condom use
- Reduced unprotected sex with
HIV-negative partners
Study Sample
The baseline study sample of 310 HIV-positive adolescents is characterized
by the following:
- 37% Hispanic, 27% African
American, 19% White, and 17% Other
- 72% Male, 28% Female
- 63% homosexual or bisexual
- Mean age of 21 years, range:
13-24 years
- 55% completed high school
education, 31% did not complete high
school
Recruitment Settings
Hospital-based adolescent medical clinics or
community-based agencies serving youth
Eligibility Criteria
HIV-positive youth were eligible if they
were between 13 and 24 years old and
received care at the participating clinical
care sites. Parental consent was obtained
for youth under age 18.
Assignment Method
Cohorts of about 15 HIV-positive youths (N =
27 cohorts, 310 youth) were assigned
sequentially to 1 of 2 groups: TLC (n = 16
cohorts, 208 youth) or wait list control (n
= 9 cohorts, 102 youth).
Comparison Group
Youth in the control group received
standard care at the adolescent clinical
care sites and were provided the
intervention at the study’s conclusion.
Relevant Outcomes Measured and Follow-up Time
Sex behaviors during past 3 months
(including overall number of partners, not
having sex, condom use, unprotected sex, and
substance use during sex) were measured at
15 months after baseline, which translate to
3 months after completion of the Act Safe
module.
Participant Retention
- TLC Intervention:
69% retained at 3 months after Act
Safe module (among those eligible)
- Comparison:
61% retained at 3 months after Act
Safe module (among those eligible)
Significant Findings
- TLC participants were significantly
more likely to report no sexual risk
pattern (no sex or 100% condom use) than
control participants (p < .05) at 3
months after Act Safe module.
- The TLC participants reported
significantly lower percentages of
unprotected vaginal and anal sex acts
with HIV-negative partners than the
control group (p < .05) at 3 months
after Act Safe module.
Considerations
- This intervention fails to meet the best-evidence criteria due to small
analytical sample sizes and low retention rates.
- TLC was developed as a 3-module intervention. Module 3 (Being
Together) consists of 8 sessions (2 hours each over a 3 month period)
focusing on improving quality of life. No published report has evaluated the
intervention effects of all three modules on HIV risk behaviors. Therefore,
module 3 is not presented here.
- A substantial number of participants were not eligible for participation
in the Act Safe module because the funding period was ending before
their follow-up would have been completed. It does not appear that this
logistical issue would affect the interpretation of the findings, however
the analyses are based on small sample sizes.
- The original research targeted teens and youth (ages 13 to 24), however,
the intervention package has been expanded to target young people (up to 29
years old).
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References and Contact Information
- Rotheram-Borus, M. J., Lee, M. B.,
Murphy, D. A., Futterman, D., Duan, N.,
Birnbaum, J. M., et al. (2001). Efficacy
of a preventive intervention for youths
living with HIV. American Journal of
Public Health, 91, 400-405.
- Rotheram-Borus, M., Murphy, D.A.,
Coleman, C., & Swendeman, D. (2002)
Counseling adolescents: Designing
interventions to target routines,
relationships, roles, and stages of
adaptation. In Chesney, M.A., Antoni,
M.H. (Eds.), Innovative approaches to
health psychology: Prevention and
treatment lessons from AIDS (pp.
15-44). Washington, DC: American
Psychology Association.
- Rotheram-Borus, M., Murphy, D.A.,
Wight, R.G., Lee, M.B., Lightfoot, M.,
Swendeman, D., et al. (2001). Improving
the quality of life among young people
living with HIV. Evaluation and
Program Planning, 24, 227-237.
Researcher: Dr. Mary Jane Rotheram-Borus
Department of Psychiatry, University of California Los Angeles
10920 Wilshire Blvd., Suite 350
Los Angeles, CA, 90024-6521
email:
rotheram@ucla.edu
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