Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
Young men soon to be released from prison
Goals of Intervention
- Eliminate or reduce risk behaviors
for HIV, STD and hepatitis
Brief Description
START is a 6-session
individual-level HIV, STD, and hepatitis
risk reduction intervention for men soon
to be released from prison incorporating
features of prevention case management,
motivational interviewing, and
incremental risk reduction. This
intervention consists of 2 individual
sessions conducted within the 2 weeks
before release and 4 individual sessions
at 1, 3, 6, and 12 weeks after release.
In the first in-prison session, the
interventionist assessed the
participant’s knowledge of HIV/AIDS,
STD, and hepatitis, conducted a brief
HIV-risk assessment, and helped the
participant develop a personal
risk-reduction plan. The interventionist
also provided information, skills
training, and referrals and helped to
identify incremental steps towards risk
reduction. The second in-prison session
focused on community reentry needs and
referrals for housing, employment,
finances, substance abuse, mental
treatment, legal issues, and avoiding
reincarceration. The post-release
sessions involved a review of the
previous sessions and discussion of the
facilitators and barriers to
implementing the risk reduction plan.
Additional sessions were available for
participants in the enhanced session as
needed during the intervention period. |
Theoretic Basis
The intervention did not have an
explicit theoretical basis. It was based on
behavior change strategies and principles
Intervention Duration
The pre-release sessions lasted 60 to 90
minutes and were provided during the 2 weeks
prior to release from prison; the
post-release sessions lasted 30 to 60
minutes and were provided approximately 1,
3, 6, and 12 weeks after release from
prison, totaling approximately 4 – 7 hours
over a period of 14 weeks.
Intervention Settings
The pre-release sessions were provided
inside the prison; the post release sessions
were conducted in community/private settings
such as community based organizations. Some
post-release sessions were conducted by
telephone. For inmates who were
reincarcerated, post-release sessions were
provided in the prison or jail.
Deliverer
Men and women trained facilitators
Delivery Methods
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Intervention Package Information
An intervention package is currently being developed with funding from CDC’s
Replicating Effective Programs (REP) Project. Please contact Barry Zack,
Centerforce, 2955 Kerner Blvd., 2nd Fl, San Rafael, CA 94901, email:
bzack@centerforce.org, for details on
intervention materials
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Evaluation Study and Results
The original evaluation study was
conducted in 2001-2002 with inmates from
four state prison systems in California,
Mississippi, Rhode Island, and Wisconsin.
Key Intervention Effects
Study Sample
The baseline study sample of 522 incarcerated men is characterized by the
following:
- 52% African American, 23% White,
14% Hispanic, 12% other
- 100% Male
- 23% 18-21 years of age, 48% 22-25
years, 20% 26-29 years
- 55% completed high school
education or GED
Recruitment Settings
Eight state prisons
Eligibility Criteria
Men were eligible if they were: (1) 18-29
years old, (2) able to speak English, (3)
had been or expected to be incarcerated for
at least 90 days, (4) scheduled for release
from prison within 14-60 days, (5) able to
provide informed consent, (6) willing to
provide post release contact information,
and (7) expected to be released to an
unrestricted environment in site-specific catchment areas.
Assignment Method
Men (N = 522) were assigned to 1 of 2 groups: START Intervention (n
= 263) or single-session comparison (n =
259) – using an alternating sequence based
on the month of recruitment (for prisons in
California or Rhode Island) or the month of
anticipated release (for prisons in
Mississippi and Wisconsin) over a 24-month
period.
Comparison Group
The comparison group received a
single individual-level session, conducted
approximately 2 weeks prior to release from
prison, which consisted of a brief HIV-risk
assessment and risk reduction plan. The
interventionist provided information, skills
training, and referrals as required and
worked with the participant to identify
incremental steps towards risk reduction.
Relevant Outcomes Measured and Follow-up Time
- Sex behaviors were measured as
number of times each type of sex was
performed (e.g., vaginal, insertive and
receptive oral sex, insertive and
receptive anal sex) and number of times
condoms were used for each type of sex.
These behaviors were measured for each
of the following types of partners: any,
main, non-main, non-sterile injection
drug users, and at-risk partners.
- Sex behaviors were also measured for
at-risk partners (defined as partners
who ever injected drugs, ever had an STI,
ever smoked crack, ever traded sex for
money or drugs, currently had other
sexual partners, HIV positive status)
for each of the following types of
partners: any, main, non-main,
non-sterile injection drug users
- Recent use of injection drugs
- All outcomes were measured at 1 week
after release (recall period: time since
release from prison) and at 12 weeks and
24 weeks after release (recall period:
time since previous assessment). The
1-week and 12-week assessments were both
collected during the intervention, and
the 24-week assessment translates to a
3-month follow-up for the intervention
group. For the comparison group, the
1-week, 12-week, and 24-week assessments
translate to approximately 3-week,
14-week (3.5-month) and 26-week
(6.5-month) follow-ups, respectively.
Participant Retention
- START Intervention:
84% retained at week 1
82% retained at week 12
83% retained at week 24
- Comparison:
87% retained at week 1
76% retained at week 12
82% retained at week 24
Significant Findings
At 3 months after intervention,
intervention participants were
significantly less likely to report
unprotected vaginal or anal sex at last
sex (p < .05), with any partner (p <
.05), with a main partner (p < .05) or
with an at-risk partner at last sex (p <
.05) when compared to comparison
participants.
Considerations
- The significant findings described above were based on data collected 3
months after the intervention for both groups, however, due to the
difference in number of sessions between the two groups the outcomes were
measured at 24-weeks post-release for the Intervention group and 12-weeks
post-release for the Comparison group.
- Given the low prevalence of injection drug use in both the intervention
and comparison groups, analyses for this outcome were not performed.
- Intervention effects were also found to be significant when comparing the
24-week post-release assessment for both treatment groups, however, the
actual follow-up time since the intervention differs greatly by group and is
over twice as long for the comparison group (as described above).
- Intervention effects were not found to be significant at the 12-week
post-release assessment, which was collected just prior to the final 12-week
post-release intervention session for the Intervention group).
- In California only, at the 12-week post-release assessment only (prior to
the last session in the intervention group), the intervention group had a
greater proportion of men reporting having been reincarcerated than the
comparison men (p < .05), however, this finding could be attributed to
site-specific differences in tracking procedures rather than the
intervention itself.
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References and Contact Information
- Wolitski, R. J., & The Project START study group. (2006). Relative efficacy of a multisession sexual risk reduction intervention for young men released from prison in 4 states.
American Journal of Public Health, 96, 1845-1861.
Researcher: Dr. Richard J. Wolitski
Division of HIV and AIDS Prevention
National Center for HIV,
Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
1600 Clifton Road NE (MS E-37)
Atlanta, GA 30333
email:
rwolitski@cdc.gov
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