Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information

Intervention Description

Target Population
Young HIV-positive substance abusers

Goals of Intervention

• Reduce sexual and substance use risk behaviors
• Improve mental and physical health

Brief Description CLEAR is a 3-module intervention that is delivered in one-on-one sessions to young people living with HIV. Each of the 3 modules is comprised of 6 sessions that focuses on different target behaviors. Module 1 focuses on improving youths’ physical health, including the use of and adherence to antiretroviral medication, implementing new daily routines to stay healthy, and coping with their serostatus. Module 2 aims to reduce unprotected sex acts and substance use through the identification of situations that elicit risky behavior. In this module, participants build skills in condom use self-efficacy and negotiation of safer sex. Module 3 aims to reduce emotional distress and to increase quality of life of participants. Each participant is taught relaxation, self-instruction and meditation techniques in order to control negative emotional states. Participants also identify long-term life goals in this module.

Theoretic Basis

• Cognitive Behavior Therapy
• Social Action Theory

Intervention Duration
18 sessions total (6 sessions per module); each session lasts 1.5 hours

Intervention Settings
Coffee shops, community agencies, private rooms at collaborating sites, parks, or participants’ residences

Deliverer
Licensed therapist or clinical social worker

Delivery Methods

• Demonstration
• Exercise/games
• Goal setting
• Lectures
• Role plays and practice

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Intervention Package Information

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Evaluation Study and Results

The original evaluation study was conducted in Los Angeles and San Francisco, California, and New York City, New York between 1999 and 2003. The study included a sample of 175 young people living with HIV.

Key Intervention Effects
Increased proportion of condom-protected sex acts with all partners and with HIV-seronegative partners

Study Sample

• 42% Hispanic, 26% African American, 23% White, 8% other
• 78% Male; 22% Female
• 76% Homosexual, bisexual or questioning
• Median age of 23 years (range 16-29)

Recruitment Settings
Adolescent AIDS clinics, social service agencies, community-based organizations, and media outlets including newspapers, conferences, and community events

Eligibility Criteria
Participants were considered eligible for the evaluation if they were HIV-seropositive and used illicit drugs at least 5 times in the prior 3 months.

Assignment Method
Participants were randomly assigned to one of the three intervention arms: In-person intervention (n = 61), Telephone-delivered intervention (n = 59), or wait-list control (n = 55).

Comparison Group
The wait list control group received a delayed intervention.

Relevant Outcomes Measured and Follow-up Time

• Sexual risk behaviors during the prior 3 months (including number of HIV-negative sex partners, percentage of protected acts with all partners, percentage of protected acts with HIV-negative partners, consistent condom use and abstinence) were assessed at 3, 6, 9 and 15 months post baseline.
• Drug injection during the prior 3 months was assessed at 3, 6, 9 and 15 months post baseline.
• Follow-up time points translate to during the intervention and 1.5, 4.5, and 10.5 post intervention.

• In-Person Intervention:
  89% retained at 3 months
  80% retained at 6 months
  79% retained at 9 months
  84% retained at 15 months
• Telephone-delivered Intervention:
  85% retained at 3 months
  71% retained at 6 months
  90% retained at 9 months
  80% retained at 15 months
• Wait List Control: 
  84% retained at 3 months
  80% retained at 6 months
  82% retained at 9 months
  78% retained at 15 months

Significant Findings
At 15 months post baseline, participants who received the In-person CLEAR intervention reported significantly greater increases in the proportion of protected sex acts with all sex partners (p < 0.01) and proportion of protected sex acts with HIV-seronegative partners (p < 0.05) than wait list control participants. Participants receiving the In-person intervention also reported a significantly greater increase in the proportion of protected sex acts with HIV-negative partners at 15 months post baseline than participants in the Telephone-delivered intervention (p < 0.01).

Considerations

• The Telephone-delivered intervention did not meet the Best Evidence criteria, because the In-person intervention resulted in a significantly greater proportion of protected sex acts than the Telephone-delivered intervention and the Telephone-delivered intervention was not efficacious in reducing risk behaviors relative to the control group. Only the In-person CLEAR intervention is considered to meet the Best Evidence criteria.
• Other targeted outcomes – substance use, HIV medication adherence, health behaviors, and emotional distress – were not significantly improved by the intervention.

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References and Contact Information

• Rotheram-Borus, M., Swendeman, D., Comulada, S., Weiss, R.E., Lee, M., & Lightfoot, M. (2004). Prevention for Substance-Using HIV Positive Young People: Telephone and In-Person Delivery. Journal of Acquired Immune Deficiency Syndrome, 37 (2) S68-S77.

Researcher: Dr. Mary Jane Rotheram-Borus, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024 e-mail: rotheram@ucla.edu

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