Efficacy of a Group-Based Multimedia HIV Prevention Intervention for Women Under Community Supervision: Project WORTH

Background and Purpose: HIV/AIDS and criminal justice involvement are critical intersecting public health issues for drug-involved women. HIV rates among women on probation in New York City are reported as high as 17%, underscoring the importance of preventive interventions for this population.  This study is designed to address the need for evidence-based HIV/STI prevention approaches for drug-involved women involved in the criminal justice system. We tested the efficacy of a group-based traditional and multimedia HIV/STI prevention intervention (Project WORTH: Women on the Road to Health) among drug-involved women under community supervision on decreasing unprotected sex.

Methods: We randomized 306 women recruited from community supervision settings (probation, parole, alternative-to-incarceration programs) to receive either: 1) a four-session traditional group-based HIV/STI prevention intervention (traditional WORTH; n=101); 2) a four-session multimedia WORTH intervention that covered the same content as traditional WORTH but was delivered in a computerized format (multimedia WORTH; n=103); or 3) a four-session group-based Wellness Promotion intervention that served as an attention control condition (n=102). The study examined whether the traditional or multimedia WORTH intervention was more efficacious in reducing sexual HIV risks when compared to Wellness Promotion; and whether multimedia WORTH was more efficacious in reducing risks when compared to traditional WORTH.

Participants were assessed at baseline and with repeated assessments at three, six, and 12-months post-intervention. Primary outcomes were assessed over the 12-month post-intervention period using random-effects generalized linear models and included: number of unprotected sex acts; proportion of protected sex acts, and consistent condom use.  Sample characteristics are as follows:  Average age – 41.5; Black/African American- 68%, Latina- 15%, White or other- 17%; HIV positive at baseline- 14%; STI positive at baseline- 26%. 

Results: Participation in all four intervention sessions was high for all three conditions: Multimedia WORTH: 93%; Traditional WORTH: 93%; and Wellness Promotion: 86%.  Retention rates were also high for follow-up assessments across the three intervention arms: Three-month: 87%; Six-month: 91%; and Twelve-month: 91%. 

Over the 12-month follow up period, there was a 28% reduction in the number of unprotected sex acts for participants in multimedia and traditional WORTH when compared with participants in the Wellness Promotion condition (IRR=0.72; 95% CI=0.57 to 0.90).  Women assigned to the two WORTH conditions were also over two times more likely to report consistent condom use over the 12-month follow up period (OR=2.36; 95% CI=1.28 to 4.37). There were no significant differences in condom use outcomes between multimedia and traditional WORTH study arms.

Conclusions: This study marks the first HIV prevention trial to target women under criminal justice community supervision.  The promising effects of traditional and multimedia WORTH on increasing condom use and high participation rates suggest that WORTH may be scaled up to redress the concentrated epidemics of HIV/STIs among drug-involved women in the criminal justice system.