Results of a Cluster-Randomized Trial Evaluating the Effectiveness of a Sports-Based HIV Prevention Program for at-Risk Adolescents in Washington, DC Schools

Background: While sports-based HIV prevention interventions have promise, evaluation designs have been weak (Kaufman & Spencer, 2012). In response, we designed and now present the results of a cluster-randomized controlled trial of The Grassroot Project (TGP), an eight-session sports-based HIV prevention intervention facilitated by university athletes (near-peer role models) and implemented with adolescents in schools. The intervention was developed by Grassroot Soccer in South Africa and adapted for use in Washington, DC. Washington, DC, has a diagnosed adult HIV prevalence of 2.7% and an estimated (including undiagnosed) prevalence of 5%, making it one of the most HIV-impacted cities in the United States.

Methods: Seven schools involving 326 students (aged 12-14) were randomized to either receive the intervention during the study or to receive the intervention after data collection had been completed. Survey data were collected in intervention and control schools two weeks before the intervention and two weeks after the intervention (0 and 10 weeks). Outcomes included three kinds of knowledge (general, fluids, casual transmission), HIV stigma, attitudes about having sex, efficacy to refuse sex, intentions to have sex, and ever having had sex. Process measures included students’ program perceptions and program facilitator assessments.

Results: The program yielded significant positive changes on all three knowledge measures. No significant effects were found for other outcomes. There was a strong correlation between nearly half of the outcomes and the degree to which students related to program facilitators.

Conclusions: Results indicate that The Grassroot Project intervention improves students’ HIV-related knowledge, but the data did not indicate significant changes in students’ HIV-related attitudes, self-efficacy, intentions, or behaviors. The results also suggest that The Grassroot Project might spend more time recruiting, training, and monitoring relatable program facilitators. Given that risky sexual behaviors are more rare among Washington, DC, adolescents aged 12-14, it would be valuable for this and other studies to assess behavioral outcomes at longer follow-up intervals. Nonetheless, this study presents an intervention that is effective in improving HIV literacy, a challenge that the Washington, DC, school system has struggled to achieve.