Tuesday, January 26, 2016

The Impact of Key HIV Intervention Components as Predictors of Sexual Barrier Use: The Zambia Partner Project

Behavioral interventions have utilized a variety of strategies and components to reduce HIV risk. This article describes the partner intervention, a couple-based group HIV risk reduction intervention implemented in 6 urban community health clinics in Lusaka, Zambia, and examines the components of the intervention and their relationship with condom use. 

Couple members completed assessments on condom use, acceptability, willingness to use condoms, communication, intimate partner violence (IPV), self-efficacy, and HIV information at baseline and 6 months' follow-up. This study examined the relative impact of elements of the intervention as predictors of condom use. Changes in acceptability had the greatest overall influence on condom use, followed by social support, relationship consensus, and willingness to use condoms. Changes in self-efficacy, IPV, negotiation, and information had no influence. 

Results support the use of multidimensional approaches in behavioral interventions and highlight the importance of identifying critical elements of interventions to maximize risk reduction outcomes.

…Changes in acceptability had the greatest overall influence on sexual barrier use, followed by social support, relationship consensus, and willingness to use sexual barriers. Self-efficacy was associated with the use of sexual barriers, but increased self-efficacy did not contribute to increased barrier use in multivariable analysis. Finally, negotiation, IPV, and information had no apparent influence on sexual barrier use.

Study results provide further support for the predictive relationship between acceptability and self-reported willingness to use barriers and sexual barrier use, in line with earlier findings by this team using individual rather than dyadic analyses. One of the key elements of CB therapy is the premise that attitudes influence behavior, for example, acceptability of condoms will predict their use. In this study, acceptability may have been increased by CB strategies designed to promote positive attitudes and reduce negative opinions regarding condom use. Condoms are highly effective in the prevention of HIV transmission, but their impact as a prevention strategy has been limited by low acceptability and inconsistent use. Meta-analyses of positive prevention studies in developing countries have reported that interventions targeting HIV sero-positive individuals are successful in increasing condom use, in both seroconcordant and discordant relationships. Recent studies, for example, microbicides and preexposure prophylaxis (PrEP), have highlighted the importance of assessing the acceptability of prevention strategies as a predictor of uptake. In fact, low product acceptability may be the Achilles' heel of HIV prevention. Enhancement of product acceptability is likely a critical intervention element and has important implications for the uptake of existing prevention strategies as well as new strategies such as PrEP.

Social support and relationship consensus also played a key role in the uptake of sexual barrier products. In psychotherapy, the group format is often used to increase the overall impact of the intervention by providing a variety of viewpoints on interpersonal issues, but the group format may also increase the perception of the availability of supportive like-minded peers. In addition, the supportive nature of the group format may be more comfortable for members of collective communities and cultures, although results of previous research regarding the impact of the group format on condom use are mixed. Although no interaction was discovered, future studies should continue to explore the association between social support and relationship consensus. Both the elements of social support and the focus on achieving consensus appear to be critical intervention elements…

Full article at:  http://goo.gl/u4pTRv

By:  Ndashi Chitalu, MD,1 Mirriam Mumbi, CNM,1 Ryan Cook, BA,2 Stephen M. Weiss, PhD, MPH,2 and Deborah Jones, PhD2
1Department of Pediatrics, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
2Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
Corresponding Author: Deborah Jones, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Suite 404A, Miami, FL 33136, USA, Email: ude.imaim.dem@senojd

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