Abstract
Black/African-American girls are infected with sexually transmitted infections (STIs) at higher rates than their White counterparts. This study tested the efficacy of IMARA, a mother-daughter psychosocial STI/HIV prevention program, on adolescent Black/African-American girls' incident STIs at 12 months in a 2-arm group randomized controlled trial. Black/African-American girls 14-18 years old and their primary female caregiver were eligible for the study. Girls provided urine samples to test for N. gonorrhoeae, C. trachomatis, and T. vaginalis infection at baseline and 12-months. Mother-daughter dyads were randomly assigned to IMARA (n = 118) or a time-matched health promotion control program (n = 81). Retention at 12-months was 86% with no difference across arms. Both interventions were delivered over two consecutive Saturdays totaling 12 hours. Girls who received IMARA were 43% less likely to contract a new STI in the 12-month post-intervention period compared with those in the health promotion control program (p = .011). A secondary follow-up intent-to-treat analysis provided additional support for the protective effect of IMARA, albeit with a similar magnitude of 37% (p = .014). Findings provide early evidence for IMARA's efficacy, such that IMARA protected against STIs at 12-months among adolescent Black/African-American girls. Future research should examine the mechanisms associated with reduced STIs.
Highlights
Youth ages 15–24 years-old account for 50% of new sexually transmitted infections (STIs) annually [1, 2], yet rates vary by race/ethnicity
We compared IMARA to a health promotion control program matched in length, intensity, and time spent in joint mother-daughter activities to control for non-specific therapeutic effects associated with contact time, group relationships, and facilitator attention
This study provides preliminary efficacy data indicating that IMARA protects against incident STIs at one-year follow-up among Black/African-American adolescent girls
Summary
Youth ages 15–24 years-old account for 50% of new sexually transmitted infections (STIs) annually [1, 2], yet rates vary by race/ethnicity. Support and attachment, as well as positive (e.g., open, receptive) mother-daughter communication, are each associated with girls’ reduced sexual risk [11,12,13,14], including among Black/African-American adolescent girls [11]. A recent study showed strong mother-daughter relationships and open communication predicted less sexual risk taking among Black/African-American adolescent girls two years later [11]. In light of these findings, mothers may be effective collaborators in preventing STI in daughters [6, 15, 16]. The study is positioned to provide early but rigorous evidence for an innovative approach to alleviating STIs among Black/African-American adolescent girls, and lay the foundation for future investigation into the mechanistic pathways underlying STI prevention in this group
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