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The Research
The Intervention

The Research

The Science Behind the Package
TLC: Together Learning Choices, formerly Teens Linked to Care, is a small, group-level intervention that helps young people living with HIV/AIDS maintain health, reduce transmission of HIV and other sexually transmitted diseases, and improve their quality of life. The intervention is based on the Social Action Theory, which stresses the importance of social interactions and environmental factors in a person’s ability to control behaviors that may endanger his or her health.

Target Population
Young people living with HIV/AIDS between 13 and 24 years of age.

Interventions
TLC was originally a three-module, 31-session intervention including the Staying Healthy module (12 sessions) which encourages healthy living by focusing on health maintenance and forging effective partnerships with health care providers; the Acting Safe module (11 sessions) dedicated to primary and secondary HIV prevention by addressing risk behaviors related to sex and substance use, and reducing new infections and reinfections; the Being Together module (8 sessions) which emphasizes emotional well-being and improving quality of life. However, during translation and packaging, the Being Together module was not included as part of the intervention package because the module was not rigorously evaluated, and the outcomes were not linked to HIV risk reduction. Furthermore, the remaining two modules-- Staying Healthy and Acting Safe were reduced to 8 sessions each for a total of 16 sessions. This change was necessary for ease of implementing the intervention by agencies.

TLC participants are taught skills in problem-solving, goal-setting, assertive behavior and communication, awareness of feelings, thoughts, and actions, and safer sex negotiation. The intervention is delivered using techniques that include role play, identification of ideal selves, use of Feeling Thermometer to help participants assess and discuss their feelings of discomfort, and use of Thanks Token to appreciate and reinforce positive behavior of participants. The sessions are highly interactive, and delivered in small groups of about 15 participants. They can be held in a clinic or at a community agency in a large room that is free of interruptions. Two facilitators are required to conduct the sessions.

Research Results
The Staying Healthy module led to increase in positive lifestyles, use of positive coping styles among females, and seeking and obtaining social support. The Staying Healthy and Acting Safe modules together resulted in fewer percentage of sex acts that were unprotected, based on intent-to-treat analyses.

For Details on the Research Design
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 youth living with HIV. American Journal of Public Healthh, 91:400-405.

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The Intervention

A Package Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated project that identifies HIV/AIDS prevention interventions with demonstrated evidence of effectiveness. REP supports the original researchers in developing a user-friendly package of materials designed for prevention providers. TLC is one of the REP interventions and is the product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives. The package has been field tested in one clinic and one HIV prevention agency by non-research staff. Following the field test the target audience was broadened to include young adults up to 29 years, and the intervention was renamed Together Learning Choices (TLC) to accommodate a wider range of care and services available to young people living with HIV/AIDS. This intervention package is therefore intended for young people between 13 and 29 years of age, who are living with HIV/AIDS.

Core Elements
Core elements are intervention components that must be maintained without alteration to ensure program effectiveness. The core elements of TLC include:

• Development of emotional awareness through use of a Feeling Thermometer and identification of the link between feelings, thoughts, and actions (Feel-Think-Do Framework).
• Teaching, modeling, and practicing four TLC essential skills:
  • Personal Problem-Solving.
  • Short- and Long-term Goal Setting.
  • Emotional Awareness and Regulation.
  • Assertive Behavior and Communication.
• Consistent appreciation and reinforcement of positive participant behavior through the use of Thanks Tokens.
• Identification of Ideal Self to help motivate and personalize behavior change.
• Sessions delivered in highly participatory, interactive groups.

Package Contents

• A three-part Implementation manual that includes an Introduction and Overview to TLC (part 1), Facilitator’s Guides for delivering the Staying Healthy sessions (part 2) and the Acting Safe (part 3) modules.
• Supplemental materials needed to implement the intervention.
• TLC Marketing Video.

Intervention Orientation
Program staff who will be facilitating the TLC intervention attend a 5-day training in which they learn how to conduct the intervention, practice intervention delivery skills, and identify agency-specific implementation strategies.

Technical Assistance
Development and pilot testing of the intervention package have been completed. Dissemination of TLC materials will be available soon.

Timeline for Availability
Development and pilot testing of the intervention package have been completed. Dissemination of TLC materials will be available soon.

For More Information on the TLC Package
To find out more about future trainings and technical assistance, please contact Kimberly Hearn of the Capacity Building Branch, CDC, e-mail khearn@cdc.gov, or telephone (404) 639-8189.

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