Evidence-based sexual and reproductive health intervention using a multiphase optimization strategy

ABSTRACT Latina adolescents in the U.S. are disproportionately affected by HIV/AIDS/sexually-transmitted infections (STIs) and other adverse consequences of risky sexual behavior. The home environment is recognized to shape adolescents' health outcomes, but only one Latina mother-daughter sexual health program was

identified in the literature. IMARA (Informed, Motivated, Aware, and Responsible Adolescents and Adults) is an evidence-based intervention for African American adolescent girls and their mothers, which is well-suited to be adapted for Latinas. In a randomized controlled trial (RCT) in Chicago, the program reduced the risk of new

STIs by 45% compared to the control group among 14-18-year-olds. In this K99/R00 award, I propose to adapt IMARA to a Latina audience and pilot an optimization trial within community-based organizations (CBOs) in Chicago, using the multiphase optimization strategy (MOST). MOST is a methodological framework for developing an optimal intervention package by assessing the effectiveness of an intervention's

components prior to subjecting the intervention to an RCT. This grant focuses on the preparation phase of MOST, using an implementation science (IS) approach and drawing on community-based participatory research (CBPR) principles to pursue three specific aims: 1) adapt the intervention for Latinas by establishing

a community advisory board and engaging 12 mother-daughter dyads in 4 focus group discussions (K99 phase); 2) establish the acceptability, feasibility, and appropriateness of the intervention components through piloting among 24 new dyads (K99 phase); and 3) pilot an optimization trial of the adapted intervention among

92 new dyads and examine intervention component effects on risky sexual behavior (primary outcome) and STI incidence (secondary outcome) (R00 phase). These research aims will allow me to build on my strong research and publishing experience in adolescent health and capitalize on the expertise of my mentorship

team in sexual risk interventions for youth to achieve four training aims, to: 1) gain knowledge in CBPR principles and their application; 2) develop expertise in IS theory/design and its application; 3) learn to employ innovative research designs, analysis strategies, and frameworks for behavioral interventions, including MOST;

and 4) further my professional development to obtain a tenure-track faculty position prior to the R00 phase. I will accomplish my training aims through meetings, directed readings, and conference/workshop attendance, with support from my mentors (Primary Mentor: Geri Donenberg). Findings will form the basis of an R01

application for a fully-powered optimization trial to test intervention component impacts on STI incidence among Latina adolescents. The long-term goal is to generate an efficient, sustainable adapted intervention with potential for scale-up with CBOs serving Latinas. This K99/R00 award will give me a platform on which to

launch my career as an independent adolescent health researcher, specialized in innovative methods for developing, implementing, and evaluating behavioral interventions.