Implementation of a couple-based HIV prevention program: a cluster randomized trial comparing manual versus Web-based approaches

Abstract

BackgroundDespite great need, the number of HIV prevention implementation studies remains limited. The challenge for researchers, in this time of limited HIV services agency resources, is to conceptualize and test how to disseminate efficacious, practical, and sustainable prevention programs more rapidly, and to understand how to do so in the absence of additional agency resources. We tested whether training and technical assistance (TA) in a couple-based HIV prevention program using a Web-based modality would yield greater program adoption of the program compared to training and TA in the same program in a manual-based modality among facilitators who delivered the interventions at 80 agencies in New York State.MethodsThis study used a cluster randomized controlled design. Participants were HIV services agencies (N = 80) and up to 6 staff members at each agency (N = 253). Agencies were recruited, matched on key variables, and randomly assigned to two conditions. Staff members participated in a four-day, face-to-face training session, followed by TA calls at two and four months, and follow-up assessments at 6, 12, and 18 months post- training and TA. The primary outcomes examined number of couples with whom staff implemented the program, mean number of sessions implemented, whether staff implemented at least one session or whether staff implemented a complete intervention (all six sessions) of the program. Outcomes were measured at both the agency and participant level.ResultsOver 18 months following training and TA, at least one participant from 13 (33%) Web-based assigned agencies and 19 (48%) traditional agencies reported program use. Longitudinal multilevel analysis found no differences between groups on any outcomes at the agency or participant level with one exception: Web-based agencies implemented the program with 35% fewer couples compared with staff at manual-based agencies (IRR 0.35, CI, 0.13-0.94).ConclusionGreater implementation of a Web-based program may require more resources and staff exposure, especially when paired with a couple-based modality. Manual-based and traditional programs may hold some advantage or ease for implementation, particularly at a time of low economic resources.Trial registrationClinicalTrials.gov identifier: NCT01863537

Couple-Based Behavioral HIV Interventions by the Social Intervention Group: Progress, Gaps, and Future Directions

“…For the SMART Couples study, which focused on antiretroviral medication treatment adherence, participants were recruited from hospital-based HIV care clinics (Remien et al, 2005). Agencies solicited for participation in Multimedia Connect were contacted by email and phone (Witte et al, 2014).…”

“…RCTs either included three arms: an individual intervention arm, couple intervention arm, and control arm; or two arms: the couple-based intervention and a control (Table 1). The implementation study on Multimedia Connect (Witte et al, 2014) utilized a cluster RCT design that randomized HIV services agencies (n = 80) and included up to six staff members at each agency as participants (n = 253). Agencies were recruited, matched on key variables, and randomly assigned to one of two conditions (Witte et al, 2014).…”

“…The implementation study on Multimedia Connect (Witte et al, 2014) utilized a cluster RCT design that randomized HIV services agencies (n = 80) and included up to six staff members at each agency as participants (n = 253). Agencies were recruited, matched on key variables, and randomly assigned to one of two conditions (Witte et al, 2014).…”

“…Responding to the call for increased implementation science in HIV prevention studies, as well as promotion of digital technologies, the Multimedia Connect implementation study (Witte et al, 2014) tested whether training and technical assistance (TA) for a couple-based HIV prevention program using a web-based modality would yield stronger adoption of the program compared to training and TA in the same program with a traditional, manual-based modality. We recruited agencies and matched them on key variables (number of full- and part-time paid staff providing HIV prevention services in the prior year; and number of clients receiving multi-session HIV prevention services in the prior year), and randomly assigned them to the conditions.…”

Feasibility and initial efficacy of a culturally sensitive women-centered substance use intervention in Georgia: Sex risk outcomes

“…If the former circumstance is true, then we would need to further adapt RBT + WC so it addressed the needs of injection-drug-using women with a stable heterosexual sex partner. Such an intervention could be tailored along the lines of the couple-based intervention developed by El-Bassel, Gilbert, and colleagues [ 38 – 42 ]. Tailoring could be based in part on our own research with treating female partners of opioid-injecting men in Georgia [ 43 ].…”