Open AccessA hybrid effectiveness/implementation trial of an evidence-based intervention for HIV-serodiscordant African American couples.
Author(s) -
Gail E. Wyatt,
Alison Hamilton,
Tamra Burns Loeb,
Nicholas J. Moss,
Muyu Zhang,
Honghu Liu
Publication year - 2020
Publication title -
american psychologist/the american psychologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.124
H-Index - 230
eISSN - 1935-990X
pISSN - 0003-066X
DOI - 10.1037/amp0000712
Subject(s) - serodiscordant , psychological intervention , baseline (sea) , intervention (counseling) , medicine , vulnerability (computing) , cluster randomised controlled trial , condom , randomized controlled trial , demography , human immunodeficiency virus (hiv) , gerontology , family medicine , psychology , psychiatry , viral load , antiretroviral therapy , sociology , political science , surgery , computer security , syphilis , computer science , law
Couples-based behavioral HIV prevention interventions have demonstrated efficacy, but few are routinely available in community-based settings in the United States. The Eban intervention, designed for heterosexual African American serodiscordant couples and proven efficacious in a cluster randomized trial, was implemented in community-based HIV service organizations in two cities disproportionately affected by the HIV epidemic. This article reports primarily on the effectiveness results related to condom use and results related to retention challenges within a Hybrid Type 2 implementation/effectiveness trial. Ninety-one individuals enrolled at baseline; 39 completed the posttest, and 30 completed the 3-month follow-up. Although condom use did not monotonically increase from baseline to posttest and 3-month follow-up, it did increase from baseline (44%) to posttest (73%), and from baseline to 3-month follow-up with an overall positive slope of Time 0.13 to 0.14 (p < .001). There was a significant increase in the number of people who used condoms 100% of the time from baseline (36.3%) to posttest (56.4%; p = .04) but not from baseline to 3-month follow-up (46.7%; p = .2907). Challenges with resources as basic as housing, food, and transportation complicated participation (and therefore implementation) and may have impeded couples' maintenance of risk reduction strategies beyond the intervention. In light of couples' numerous observed vulnerabilities, we constructed a composite score of "critical vulnerability" and found that depression was persistently related to critical vulnerability and that retention was higher among those with less vulnerability. These findings highlight the important yet underaddressed role of patient-level factors in the process and outcomes of hybrid implementation/effectiveness research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).