Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Comulada, W. S., Weiss, R. E., Cumberland, W., & Rotheram-Borus, M. J. (2007). Reductions in drug use among young people living with HIV. American Journal of Drug and Alcohol Abuse, 33(3), 493-501. 
Rotheram-Borus, M. J., Swendeman, D., Comulada, W. 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 Syndromes, 37(Suppl. 2), S68-S77.
Supplementary Materials Gribble, J. N., Miller, H. G., Rogers, S. M., & Turner, C. F. (1999). Interview mode and measurement of sexual behaviors: Methodological issues. Journal of Sexual Research, 36, 16-24.
Lightfoot, M., Swendeman, D., Rotheram-Borus, M. J., Comulada, W. S., & Weiss, R. (2005). Risk behaviors of youth living with HIV: Pre- and post-HAART. American Journal of Health Behavior, 29(2), 162-171.
Lightfoot, M., Tevendale, H., Comulada, W. S., & Rotheram-Borus, M. J. (2007). Who benefited from an efficacious intervention for youth living with HIV: A moderator analysis. AIDS and Behavior, 11(1), 61-70.
The National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial Group. (1998). The NIMH Multisite HIV Prevention Trial: Reducing HIV sexual risk behavior. Science, 280(5371), 1889-1894.
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 youths living with HIV. American Journal of Public Health, 91(3), 400-405.
Rotheram-Borus, M. J., Murphy, D. A., Wight, R. G., Lee, M. B., Lightfoot, M., Swendeman, D., et al. (2001). Improving the quality of life among young people living with HIV. Evaluation and Program Planning, 24, 227-237.
Schrimshaw, E. W., Rosario, M., Meyer-Bahlburg, H. F. L., & Scharf-Matlick, A. A. (2006). Test-retest reliability of self-reported sexual behavior, sexual orientation, and psychosexual milestones among gay, lesbian, and bisexual youths. Archives of Sexual Behavior, 35(2), 225-234.
Turner, C. F., Ku, L., Rogers, S. M., Lindberg, L. D., Pleck, J. H., & Sonenstein, F. L. (1998). Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science, 280(5365), 867-873.
Outcomes
| Outcome 1: Substance use frequency |
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Description of Measures
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Substance use frequency was measured by each participant's self-report of the number of days and the average number of times per day in the past 3 months he or she used cocaine, crack cocaine, inhalants, marijuana, opiates, methamphetamines, and stimulants.
Participants were assessed with audio computer-assisted self-interviewing (ACASI) technology at baseline and at 3, 6, 9, and 15 months after baseline (follow-ups).
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Key Findings
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In a multisite randomized clinical trial, HIV-positive and drug-using adolescents and young adults (aged 16-29 years) referred from AIDS clinics and community-based sites in three cities (Los Angeles, New York, and San Francisco) were assigned to one of three conditions: one-on-one, in-person delivery of the intervention (in-person CLEAR); one-on-one telephone delivery of the intervention (telephone CLEAR); or a delayed-intervention control. From baseline to the 15-month follow-up:
- Among participants still using substances, those assigned to the intervention conditions reported less frequent use of the following substances in comparison with those assigned to the control condition: crack cocaine (in-person CLEAR vs. control, p < .001; telephone CLEAR vs. control, p < .001), marijuana (in-person CLEAR vs. control, p < .001; telephone CLEAR vs. control, p < .001), and methamphetamines (in-person CLEAR vs. control, p < .001; telephone CLEAR vs. control, p < .001).
- Among participants still using substances, those assigned to the telephone CLEAR condition reported less frequent use of stimulants than those assigned to the control condition (p < .001), and those assigned to the in-person CLEAR condition reported less frequent use of inhalants than those assigned to the control condition (p < .001).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.7
(0.0-4.0 scale)
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| Outcome 2: HIV sexual risk behavior (condom use) |
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Description of Measures
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HIV sexual risk behavior (condom use) was measured by each participant's self-report of the following items over the past 3 months: total number of sexual partners, total number of sexual acts, and number of specific sexual acts with each partner, as well as whether condoms were used during each of these sexual acts. A sexual partner was defined as a male or female with whom the participant engaged in vaginal or anal sex. A sexual act was defined as a single session of receptive or insertive vaginal or anal sex. The proportions of vaginal and anal sex acts protected by condoms with all partners, HIV-positive partners, and HIV-negative partners (or partners of unknown status) were calculated for each participant.
Participants were assessed with ACASI technology at baseline and at 3, 6, 9, and 15 months after baseline (follow-ups).
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Key Findings
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In a multisite randomized clinical trial, HIV-positive and drug-using adolescents and young adults (aged 16-29 years) referred from AIDS clinics and community-based sites in three cities (Los Angeles, New York, and San Francisco) were assigned to one of three conditions: one-on-one, in-person delivery of the intervention (in-person CLEAR); one-on-one telephone delivery of the intervention (telephone CLEAR); or a delayed-intervention control. From baseline to the 15-month follow-up:
- The proportion of protected sexual acts (i.e., condom use) with all sexual partners increased for participants assigned to the in-person CLEAR condition compared with those in the control condition (p < .01). The proportion of protected sexual acts with all partners did not differ significantly between participants assigned to the telephone CLEAR condition and those assigned to the control condition.
- The proportion of protected sexual acts with HIV-negative partners increased for participants assigned to the in-person CLEAR condition compared with those assigned to the telephone CLEAR condition (p < .01).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.8
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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18-25 (Young adult)
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77.7% Male
22.3% Female
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42.3% Hispanic or Latino
26.3% Black or African American
23.4% White
8% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Substance use frequency
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2.3
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2.5
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3.5
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3.4
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2.0
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2.8
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2.7
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2: HIV sexual risk behavior (condom use)
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2.8
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2.6
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3.5
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3.4
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2.0
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2.8
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2.8
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Study Strengths An earlier study with a similar sample population had high test-retest reliability for the measurement items underlying the HIV sexual risk behavior outcome. The use of an ACASI assessment format has independent support for increasing the validity of self-reported substance use and sexual behavior in this population. The intervention was manual driven and delivered by interventionists who had relevant academic degrees and who participated in a 3-day curriculum training. The implementation of intervention sessions was either audiotaped (telephone delivery) or videotaped (in-person delivery), and a random selection of taped sessions was rated for intervention fidelity, which confirmed that more than 80% of the selected intervention sessions exceeded protocol criteria and process measures for fidelity. Ninety-five percent of eligible adolescents and young adults agreed to participate in the study, and follow-up rates were adequate to good (e.g., 78% at the 6-month follow-up, 86% at the 3- and 9-month follow-ups) and similarly distributed across the three study locations. Random assignment controlled for many potential confounding variables, the comparison to a delayed-intervention control was appropriate, and an intent-to-treat model used all of the data in mixed-effect regression analyses.
Study Weaknesses No sample reliability statistics were presented for the substance use or HIV sexual risk behavior measurement items, although they were adapted from parent instruments and went through several iterations in previous studies. Self-reported substance use and HIV sexual risk behavior data were not independently validated by collateral reports from friends, parents, or main sexual partners, and the agreement of self-reported data with urine drug screens for cocaine or crack cocaine with a subset of participants at baseline was low (33%; kappa = .31). From baseline to the 15-month follow-up, participants in the delayed-intervention control condition had a reduction in substance use and fewer sexual partners, which suggests that repeated assessments alone (i.e., without the delivery of a prevention intervention) might account for some of the outcome findings. The level of incentive payments to retain participants in the study may have introduced a demand bias, and no information was provided regarding other services or interventions that study participants may have received during the follow-up period.
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Readiness for Dissemination
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
CLEAR for Program Managers (Web-based training course), http://course.cba.edc.org/
CLEAR Wall Charts:
- Feeling Thermometer
- Guidelines for Good Weekly Goals
- SMART Problem-Solving Steps
Klosinski, L., Elia, C., Swendeman, D., & Payne, J. (n.d.). Choosing Life: Empowerment! Action! Results! Comprehensive risk and counseling services. [PowerPoint slides]. Los Angeles: University of California, Los Angeles, Center for Community Health and Semel Institute for Neuroscience and Human Behavior.
Overview of Core Session Activities and Elements
Program page on the DEBI project Web site, http://www.effectiveinterventions.org/en/Interventions/CLEAR.aspx
Project CLEAR Client Flow Chart
Rotheram-Borus, M. J., & Klosinski, L. E. (n.d.). CLEAR: Choosing Life: Empowerment, Action, Results! A one-on-one intervention with youth and adults living with HIV/AIDS or at high risk for HIV infection--Implementation manual. Los Angeles: University of California, Los Angeles, Center for Community Health and Semel Institute for Neuroscience and Human Behavior.
Rotheram-Borus, M. J., Klosinski, L. E., & Elia, C. (n.d.). CLEAR: Choosing Life: Empowerment, Action, Results! A one-on-one intervention with youth and adults living with HIV/AIDS or at high risk for HIV infection--Technical assistance guide. Los Angeles: University of California, Los Angeles, Center for Community Health and Semel Institute for Neuroscience and Human Behavior.
Sample Implementation Budget for Provider Costs To Implement the Project CLEAR Intervention
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.5
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2.9
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3.8
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3.4
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Dissemination Strengths The implementation materials for this program are thorough and easy to follow. A detailed agency readiness checklist and guidance on formulating an implementation plan (i.e., how to obtain buy-in from stakeholders, job descriptions, recommended staff workloads, qualifications for staff, time commitments of staff) are available online. Training is required for facilitators and strongly recommended for their supervisors, which helps to ensure that the program is delivered with fidelity. Supervisory training covers the observation of facilitators and encourages supervisors to observe facilitators either in person or via audio- or videotape to support quality assurance during implementation. The online evaluation field guide is extensive and well organized and explains how to approach the monitoring and evaluation of program processes and outcomes. Forms and instruments facilitate data collection for monitoring and evaluation purposes. A helpful protocol for monitoring session-by-session fidelity includes an option for tracking and providing a rationale for implementation changes that deviate from the program model.
Dissemination Weaknesses Information on the implementation process is spread across documents, making it difficult to obtain a full overview. The training presentation includes few details for the development of a deeper understanding of the elements of the program model. Little guidance is provided on how to acquire training and technical assistance. Although there is considerable detail on what data to collect and how, little guidance is provided on using the collected data to improve program delivery.
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