The rate of new HIV infections is significantly higher among African-born Black women living in the US than it is among Black women born in the US. In addition, the use of pre-exposure prophylaxis, or PrEP, a daily pill to prevent HIV infection, is low among all Black women. Though risk is high, no evidence-based HIV prevention interventions designed for African-born women exist.
To address this critical gap, Tulumbe!, a partnership of African-born patients and stakeholders, was funded by PCORI to engage patients living with HIV and stakeholders in the African-born community to address HIV disparities. The Tulumbe! Partnership identified the following specific aims of this study: to culturally adapt two widely utilized, evidence-based HIV and sexually transmitted infection (STI) prevention interventions originally designed for US-born Black women—Sister-to-Sister or S2S, and Sisters Informing Sisters about Topics on AIDS or SISTA—for use by culturally diverse populations of African-born Black women, and to conduct a randomized controlled comparative effectiveness trial to determine the effects of adapted versions of Sister-to-Sister versus SISTA on increasing condom use and PrEP uptake.
Sister-to-Sister is a 20-minutes HIV and STI prevention intervention focused on teaching condom use led by a professional health educator. SISTA is a peer-led group intervention that teaches women to overcome sexual and gender inequality, promotes ethnic pride to improve self-efficacy and improve communication with male partners. Based on input from Tulumbe!, the research team believes SISTA will be more effective in addressing the primary outcomes of condom use and PrEP uptake because the intervention addresses many of the causes of HIV risk among African-born Black women.
Additional outcomes of this study are acceptance of HIV testing, new STIs, comfort using condoms, HIV-related stigma, HIV knowledge, sexual communication self-efficacy, and ability to assert oneself within sexual relationships. This study will culturally adapt both interventions and conduct a field test to determine feasibility and acceptability of the interventions. The team will then conduct a comparative effectiveness randomized controlled trial to compare the effectiveness of the culturally adapted versions of the interventions. Participants will be recruited from Massachusetts and New York City by two organizations serving African-born communities, the Multicultural AIDS Coalition/Africans for Improved Access, and African Services Committee. Half of the 424 participants will be randomly assigned to each intervention. At follow-up, participants will be asked to report self-report condom use and PrEP uptake. With permission from participants, the research team will also check participant medical records. Urine will be tested for chlamydia and gonorrhea, and HIV testing will also be offered.
Patient Investigators will serve as Key Personnel in this study, and Tulumbe! will meet monthly to contribute to study development, interpretation of findings, and dissemination of study results to participants and key stakeholders. We believe that culturally adapting and comparing the effectiveness of two widely utilized interventions among African-born women will fill a critical gap and decrease HIV risk in this population.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.