HIV preventive interventions for adolescents: a look back and ahead

Effects of a Sexual Risk-Reduction Intervention for Teenagers: A Cluster-Randomized Control Trial

This study evaluated the efficacy of the COMPAS program in the short term and 6 months after its application. For the initial sample, 2047 teenagers aged 14–19 years from 14 schools in 11 Colombian cities participated; eight schools were randomly assigned to the experimental condition and six to the control group. The participants completed self-report assessments that evaluated several variables theoretically associated with protective sexual behaviors. In the short term, the experimental group showed increased knowledge about HIV and other STIs, sexual assertiveness, self-efficacy, greater behavioral intention toward condom use, and more favorable attitudes toward HIV and condom use than the control group. After 6 months, most psychological and health variables also showed a significant positive change. In conclusion, the COMPAS program is the first school-based sexuality education program that has been shown to be effective in reducing mediating and behavioral variables associated with sexual risk reduction in Colombia.

Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial

BACKGROUND

America's increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness.

OBJECTIVE

This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth.

METHODS

Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270).

RESULTS

The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019.

CONCLUSIONS

This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/11165.

Antiretroviral therapy in HIV-infected adolescents: clinical and pharmacologic challenges

INTRODUCTION

With the currently available combined antiretroviral therapy regimens, durable suppression of viral replication, preservation of immune function and normalizing life expectancy, are all becoming achievable goals. Teenagers and young adults living with HIV present unique clinical and pharmacologic challenges to optimizing antiretroviral treatment outcomes. Areas covered: In this expert review of the topic, we examine recent clinical trial data and draw on our program's 25 year experience working with both perinatally and behaviorally HIV infected adolescents. Expert commentary: In order to be effective, the antiretrovirals we provide must be combined with multidisciplinary interventions and ongoing socio-behavioral support to ensure treatment adherence and prevent the emergence of viral resistance.

Adolescents display distinctive tolerance to ambiguity and to uncertainty during risky decision making

Although actuarial data indicate that risk-taking behavior peaks in adolescence, laboratory evidence for this developmental spike remains scarce. One possible explanation for this incongruity is that in the real world adolescents often have only vague information about the potential consequences of their behavior and the likelihoods of those consequences, whereas in the lab these are often clearly stated. How do adolescents behave under such more realistic conditions of ambiguity and uncertainty? We asked 105 participants aged from 8 to 22 years to make three types of choices: (1) choices between options whose possible outcomes and probabilities were fully described (choices under risk); (2) choices between options whose possible outcomes were described but whose probability information was incomplete (choices under ambiguity), and (3) choices between unknown options whose possible outcomes and probabilities could be explored (choices under uncertainty). Relative to children and adults, two adolescent-specific markers emerged. First, adolescents were more accepting of ambiguity; second, they were also more accepting of uncertainty (as indicated by shorter pre-decisional search). Furthermore, this tolerance of the unknown was associated with motivational, but not cognitive, factors. These findings offer novel insights into the psychology of adolescent risk taking.

Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents

The aim is to evaluate the effects of the Competencias para adolescentes con una sexualidad saludable (COMPAS) program and compare them with an evidence-based program ( ¡Cuídate!) and a control group (CG). Eighteen public high schools were randomly assigned to one of the three experimental conditions. Initially, 1,563 Spanish adolescents between 14 and 16 years of age participated, and 24 months after their implementation, 635 of them completed a survey. Self-report measures collected data on sexual behavior, knowledge, attitudes, intention, sexual risk perception, and perceived norm. Compared to the CG, COMPAS increased the level of knowledge about sexually transmitted infections and improved the attitudes toward people living with human immunodeficiency virus at the 2-year follow-up. Neither intervention had a long-term impact on behavioral variables. Results suggest that COMPAS has a comparable impact to the other intervention on the variables predicting consistent condom use. Reinforcing the messages and skills that have the greatest impact on condom use and adding booster sessions following program completion as strategies to maintain long-term effects are necessary.

Network correlates of sexual health advice seeking and substance use among members of the Los Angeles House and Ball communities

House and Ball communities (HBCs), represent a prime context for human immunodeficiency virus prevention with African American young men who have sex with men and transgender persons. This study sought to understand the composition and function of social support and sexual networks of HBC members in Los Angeles, California (N = 263). Participants were recruited using venue-based sampling and asked to report on sexual health advice seeking, alcohol use and illicit substance use. Participants were more likely to seek sexual health advice from social support network members compared with sexual network members [odds ratio (OR): 2.50, P < 0.001]. HBC members were more likely to get drunk (OR: 1.57; P < 0.05) and use illicit substances (OR: 1.87; P < 0.10) with House members and sexual network members compared with non-House members and social support network members. Health promotion programs tailored for the HBC should encourage open communication regarding sexual health; these interventions must include information about the role of substance use in sexual risk taking.

Breastfeeding behavior among adolescents: initiation, duration, and exclusivity

PURPOSE

Despite a substantial amount of evidence on breastfeeding among non-adolescent mothers, research and strategies uniquely designed to target adolescent mothers are critical because their rates of breastfeeding are disproportionately low and their transition to parenthood is often unlike that of older mothers. Literature to date, however, offers limited evidence for designing effective interventions. Therefore, we aimed to fill this gap in the literature by examining breastfeeding behaviors among a cohort of female adolescents as they transition to parenthood.

METHODS

Data were derived from a longitudinal cohort of pregnant adolescent females (ages 14-21 years) and their male partners, observed from pregnancy through 6 months postpartum. Means and frequencies were used to describe breastfeeding experiences, breastfeeding behaviors, and sociodemographic characteristics. We used multivariate logistic regression and Cox proportional hazards models to identify factors independently associated with breastfeeding initiation, exclusive breastfeeding, and breastfeeding duration.

RESULTS

Approximately 71% initiated breastfeeding. Intending to breastfeed, having had complications in labor and delivery, and lower social support were associated with greater odds of breastfeeding initiation. Of the adolescent mothers who initiated breastfeeding, 84% had stopped by 6 months postpartum; among those, average breastfeeding duration was 5 weeks. Participants who exclusively breastfed had longer breastfeeding duration, and participants who had experienced intimate partner violence had shorter breastfeeding duration. Obese women and women who had more difficulty breastfeeding had lower odds of exclusive breastfeeding.

CONCLUSIONS

Enhanced clinical support and the promotion of exclusive breastfeeding should be considered when designing interventions to improve breastfeeding rates among adolescent mothers.

Pregnancy desire among a sample of young couples who are expecting a baby

CONTEXT

Adolescents' desire for a pregnancy has been explored more among females than among males. A more comprehensive understanding of teenagers' pregnancy desires is needed to inform pregnancy prevention efforts and to support couples as they undergo the transition to parenthood.

METHODS

In an observational cohort study conducted in 2007-2011 at clinics in Connecticut, data were collected from 296 couples (females aged 14-21 and their partners) who were expecting a baby. The degree to which each partner had wanted the pregnancy and partners' perceptions of each other's pregnancy desires were assessed. Multilevel regression models examined associations between pregnancy desire and individual, partner, family and community characteristics, and between desire and life and relationship satisfaction.

RESULTS

Forty-nine percent of females and 53% of males reported having wanted the pregnancy. Pregnancy desire scores were positively associated with being male, expecting a first baby, perceived partner desire and parental response to the pregnancy; scores were negatively associated with being in school, being employed and parental support. Females' perceptions of their partners' pregnancy desires were slightly more accurate than males' (kappas, 0.36 and 0.28, respectively). Pregnancy desire was positively associated with both life and relationship satisfaction, particularly among males.

CONCLUSIONS

Adolescents' pregnancy desires require further attention as a possible focus of pregnancy prevention efforts, and health care providers may want to ensure that young couples with unwanted pregnancies are offered additional psychological and social services as they transition to parenthood.

Future expectations among adolescents: a latent class analysis

Future expectations have been important predictors of adolescent development and behavior. Its measurement, however, has largely focused on single dimensions and misses potentially important components. This analysis investigates whether an empirically-driven, multidimensional approach to conceptualizing future expectations can substantively contribute to our understanding of adolescent risk behavior. We use data from the National Longitudinal Survey of Youth 1997 to derive subpopulations of adolescents based on their future expectations with latent class analysis. Multinomial regression then determines which covariates from Bronfenbrenner's ecological systems theory are associated with class membership. After modeling these covariates, we examine whether future expectations is associated with delinquency, substance use, and sexual experience. Our analysis suggests the emergence of four distinct classes labeled the Student Expectations, Student/Drinking Expectations, Victim Expectations, and Drinking/Arrest Expectations classes according to their indicator profiles. These classes differ with respect to covariates associated with membership; furthermore, they are all statistically and differentially associated with at least one adolescent risk behavior. This analysis demonstrates the additional benefit derived from using this multidimensional approach for studying future expectations. Further research is needed to investigate its stability and role in predicting adolescent risk behavior over time.

In the heart or in the head: relationship and cognitive influences on sexual risk among young couples

Few studies examine how relationship factors influence sexual risk. We investigated gender differences of the influence of relationship functioning on sexual risk behavior and sexually transmitted infections (STIs) among 296 young pregnant couples. Compared to women, men were twice as likely to have a concurrent partner, were less likely to intend to be monogamous in the future, had less HIV/STI knowledge and more perceived risk for HIV/STI, negative attitudes and efficacy toward condom use (all P < 0.05). For men, poor relationship functioning related to less intentions to be monogamous, more partner concurrency, worse sexual communication, and more condom use. For women, poor relationship functioning related to worse sexual communication and less condom use. In addition, women who had good relationship functioning and women who had partners with poor relationship functioning were more likely to have an STI. These results demonstrate the need to include heterosexual men and relationship factors in HIV prevention.

Effect of a grade 6 HIV risk reduction intervention four years later among students who were and were not enrolled in the study trial

PURPOSE

To assess the long-term impact of HIV-prevention interventions delivered to youth before sexual initiation and the effects of interventions delivered in nonstudy settings.

METHODS

A five-group comparison of HIV knowledge, and condom-use skills, self-efficacy, intentions, and practice among 1,997 grade 10 students attending one of the eight government high schools in Nassau, The Bahamas. Group 1 received an HIV-prevention intervention, Focus on Youth in the Caribbean (FOYC), in grade 6 as part of a randomized trial; group 2 received FOYC as part of the regular school curriculum but outside of the trial; group 3 received the control condition as part of the trial; group 4 received the control condition as part of the school curriculum but outside of the trial; and individuals in group 5 (naive controls) were not enrolled in a school receiving FOYC or the control conditon and did not participate in the trial.

RESULTS

FOYC youth compared with the control youth and naive controls had higher HIV knowledge, condom-use skills, and self-efficacy 4 years later. By subgroups, group 1 demonstrated higher HIV/AIDS knowledge than all groups except group 2, higher condom skills than all groups, and higher condom self-efficacy than Naive Controls. Youth in group 2 demonstrated higher HIV knowledge than youth in groups 3-5. Behavioral effects were not found.

CONCLUSIONS

FOYC delivered to grade 6 students continued to have protective effects 4 years later. Positive effects are present among youth who received FOYC as part of the school curriculum but were not enrolled in the trial.

Text messaging for HIV prevention with young Black men: formative research and campaign development

This article describes the formative research and campaign development for a pilot study to test the feasibility of using cell phone text messaging to promote HIV prevention for young African-American men. We conducted six focus groups with Black men aged 16-20 (N=43) in order to obtain feedback on the campaign content and how best to convey sexual health information via text message using cell phones. We present three main findings: (1) the participants' ideas for conducting this research and how to structure our campaign design; (2) how we broadened our theoretical perspective from an individual focus to an empowerment and social capital focus in order to best communicate a culturally relevant program; and (3) the young adult's specific suggestions for how best to operationalize theoretical constructs related to empowerment and social capital. We found that young Black men were receptive to the idea of receiving text messages for an HIV prevention campaign. As technology proliferates, this work offers specific ideas for how to capitalize on new technological modalities to deliver important communications on prevention.

Sexual Health Information Seeking Online Among Runaway and Homeless Youth

Research shows runaway and homeless youth are reluctant to seek help from traditional health providers. The Internet can be useful in engaging this population and meeting their needs for sexual health information, including information about HIV and other sexually transmitted infections (STIs). Using a sample of homeless youth living in Los Angeles, California in June 2009, this study assesses the frequency with which runaway and homeless youth seek sexual health information via the Internet, and assesses which youth are more likely to engage in seeking health information from online sources. Drawing from Andersen's (1968) health behavior model and Pescosolido's (1992) network episode model, we develop and refine a model for seeking online sexual health information among homeless youth. Rather than testing the predicative strength of a given model, our aim is to identify and explore conceptually driven correlates that may shed light on the characteristics associated with these help seeking behaviors among homeless youth. Analyses using multivariate logistic regression models reveal that among the sample of youth, females and gay males most frequently seek sexual health information online. We demonstrate the structure of social network ties (e.g., connection with parents) and the content of interactions (e.g., e-mail forwards of health information) across ties are critical correlates of online sexual health information seeking. Results show a continued connection with parents via the Internet is significantly associated with youth seeking HIV or STI information. Similarly for content of interactions, more youth who were sent health information online also reported seeking HIV information and HIV-testing information. We discuss implications for intervention and practice, focusing on how the Internet may be used for dissemination of sexual health information and as a resource for social workers to link transient, runaway, and homeless youth to care.

The Healthy Teen Girls project: comparison of health education and STD risk reduction intervention for incarcerated adolescent females

Adolescent girls incarcerated in a state reformatory (N = 246) were recruited and assigned to an 18-session health education program or a time-equivalent HIV prevention program. Cohorts were assigned to conditions using a randomized block design separated by a washout period to reduce contamination. Post intervention, girls in the HIV risk reduction program demonstrated the acquisition of risk-reduction behavioral skills and improved condom application skill. At a follow-up assessment approximately 9 months after release from the correctional facility, girls in both conditions reported fewer unprotected sexual intercourse occasions and less sex while under the influence of alcohol or other drugs.

Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985-2008

OBJECTIVE

To provide an updated review of the efficacy of behavioral interventions to reduce sexual risk of human immunodeficiency virus (HIV) among adolescents.

DESIGN

We searched electronic databases, leading public health journals, and the document depository held by the Synthesis of HIV/AIDS Risk Reduction Project. Studies that fulfilled the selection criteria and were available as of December 31, 2008, were included.

SETTING

Studies that investigated any behavioral intervention advocating sexual risk reduction for HIV prevention, sampled adolescents (age range, 11-19 years), measured a behavioral outcome relevant to sexual risk, and provided sufficient information to calculate effect sizes.

PARTICIPANTS

Data from 98 interventions (51,240 participants) were derived from 67 studies, dividing for qualitatively different interventions and gender when reports permitted it.

MAIN OUTCOME MEASURES

Condom use, sexual frequency, condom use skills, interpersonal communication skills, condom acquisition, and incident sexually transmitted infections (STIs).

RESULTS

Relative to controls, interventions succeeded at reducing incident STIs, increasing condom use, reducing or delaying penetrative sex, and increasing skills to negotiate safer sex and to acquire prophylactic protection. Initial risk reduction varied depending on sample and intervention characteristics but did not decay over time.

CONCLUSIONS

Comprehensive behavioral interventions reduce risky sexual behavior and prevent transmission of STIs. Interventions are most successful to the extent that they deliver intensive content.

Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial

Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14-25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal care or integrated group prenatal care intervention (CenteringPregnancy Plus, CP+). Timing and content of visits followed obstetrical guidelines, from 18-week gestation through birth. Each 2-h group prenatal care session included physical assessment, education/skills building and support via facilitated discussion. Using intention-to-treat models, there were no significant differences in psychosocial function; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care. High-stress women randomly assigned to CP+ reported significantly increased self-esteem, decreased stress and social conflict in the third trimester of pregnancy; social conflict and depression were significantly lower 1-year postpartum (all p-values < 0.02). CP+ improved psychosocial outcomes for high-stress women. This 'bundled' intervention has promise for improving psychosocial outcomes, especially for young pregnant women who are traditionally more vulnerable and underserved.

Text messaging as a tool for behavior change in disease prevention and management

Mobile phone text messaging is a potentially powerful tool for behavior change because it is widely available, inexpensive, and instant. This systematic review provides an overview of behavior change interventions for disease management and prevention delivered through text messaging. Evidence on behavior change and clinical outcomes was compiled from randomized or quasi-experimental controlled trials of text message interventions published in peer-reviewed journals by June 2009. Only those interventions using text message as the primary mode of communication were included. Study quality was assessed by using a standardized measure. Seventeen articles representing 12 studies (5 disease prevention and 7 disease management) were included. Intervention length ranged from 3 months to 12 months, none had long-term follow-up, and message frequency varied. Of 9 sufficiently powered studies, 8 found evidence to support text messaging as a tool for behavior change. Effects exist across age, minority status, and nationality. Nine countries are represented in this review, but it is problematic that only one is a developing country, given potential benefits of such a widely accessible, relatively inexpensive tool for health behavior change. Methodological issues and gaps in the literature are highlighted, and recommendations for future studies are provided.

Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE) planning - anxiety, depression, quality of life

Purpose

To determine the safety of engaging HIV-positive (HIV+) adolescents in a Family Centered Advance Care (FACE) planning intervention.

Patients and methods

We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76). Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey^©, the Respecting Choices^® interview, and completion of The Five Wishes^©. The Healthy Living Control (HLC) received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation). Three-month post-intervention outcomes were: completion of advance directive (Five Wishes^©); psychological adjustment (Beck Depression, Anxiety Inventories); quality of life (PedsQL^™); and HIV symptoms (General Health Self-Assessment).

Results

Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P < 0.001). Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018) and emotional (P = 0.029) quality of life at 3 months, compared with controls.

Conclusions

Participating in advance care planning did not unduly distress HIV+ adolescents.

Pregnancy as a window of opportunity for HIV prevention: effects of an HIV intervention delivered within prenatal care

OBJECTIVES

We sought to determine whether an HIV prevention program bundled with group prenatal care reduced sexually transmitted infection (STI) incidence, repeat pregnancy, sexual risk behavior, and psychosocial risks.

METHODS

We conducted a randomized controlled trial at 2 prenatal clinics. We assigned pregnant women aged 14 to 25 years (N = 1047) to individual care, attention-matched group care, and group care with an integrated HIV component. We conducted structured interviews at baseline (second trimester), third trimester, and 6 and 12 months postpartum.

RESULTS

Mean age of participants was 20.4 years; 80% were African American. According to intent-to-treat analyses, women assigned to the HIV-prevention group intervention were significantly less likely to have repeat pregnancy at 6 months postpartum than individual-care and attention-matched controls; they demonstrated increased condom use and decreased unprotected sexual intercourse compared with individual-care and attention-matched controls. Subanalyses showed that being in the HIV-prevention group reduced STI incidence among the subgroup of adolescents.

CONCLUSION

HIV prevention integrated with prenatal care resulted in reduced biological, behavioral, and psychosocial risks for HIV.

Sexual behavior and perceived peer norms: comparing perinatally HIV-infected and HIV-affected youth

A large proportion of perinatally HIV-infected (PHIV) children are becoming adolescents and exploring their sexuality. This study explored the prevalence of sexual behaviors (kissing, touching, engaging in oral sex, or having vaginal/anal intercourse) in a sample of predominantly ethnic minority youths (N = 339; 54.1% Black and 30.4% Latino; 51% female; ages 9-16) perinatally exposed to HIV (61% HIV+). Using logistic regression, we tested the association between sexual behavior and HIV status, demographic characteristics, and peer influences regarding sexual behavior. PHIV youth were less likely to be sexually active. Among sexually active youth, PHIV youth were more likely to engage in touching behavior than HIV-negative youth and were less likely to engage in penetrative sex. Youths reporting that a greater number of their peers believed that sexually active boys were "cool" or "popular" were more likely to report sexual behavior. The association between sexual behavior and peers believing sexually active girls were "cool" or "popular" varied by age, gender, and HIV status. Furthermore, friends' sexual activity was associated with sexual intercourse. Prevention programs should strengthen messages addressing peer norms regarding sexuality, as well as address specific issues related to adolescent HIV.

Development, feasibility, and acceptability of the Family/Adolescent-Centered (FACE) Advance Care Planning intervention for adolescents with HIV

OBJECTIVES

To develop, adapt, and ensure feasibility, acceptability, and safety of the Family/Adolescent-Centered (FACE) Advance Care Planning intervention.

PATIENTS AND METHODS

Two-group, randomized, controlled trial in two hospital-based outpatient clinics in Washington, D.C. and Memphis, Tennessee, from 2006 to 2008 was conducted. Participants (n = 38 dyads) included medically stable adolescents aged 14 to 21 years with HIV/AIDS and surrogates/families over age 20. Three 60- to 90-minute sessions were conducted via a semistructured family interview with a trained/certified interviewer. Intervention received: (1) Lyon Advance Care Planning Survey; (2) Respecting Choices interview; and (3) Five Wishes. Control received (1) Developmental History, (2) Health Tips, and (3) Future Plans. Feasibility was measured by percent enrollment, attendance, retention, and completeness of data. Acceptability and safety were measured by Satisfaction Questionnaire, using longitudinal regression analysis.

RESULTS

Adolescents' mean age was 16 years; 40% were males; 92% were black; HIV transmission rate was 68% perinatal and 32% sexually acquired; 42% were asymptomatic; 29% were symptomatic; and 29% had a diagnosis of AIDS. Intervention adolescents were more likely to rate sessions positively (p = 0.002) and less likely to rate sessions negatively (p = 0.011) than controls. Guardians/surrogates were more likely to rate the sessions positively (p = 0.041) and demonstrated no difference in rating sessions negatively (p = 0.779) than controls.

CONCLUSIONS

Existing advance care planning models can be adapted for age, disease, and culture. Adolescents with HIV/AIDS were satisfied with an advance care planning approach that facilitated discussion about their end-of-life wishes with their families. Families acknowledged a life-threatening condition and were willing to initiate end-of-life conversations when their adolescents were medically stable.