This proposal fits with the NIMH priority for research aimed at developing and testing "different modes for transferring efficacious interventions" into community settings--especially with regard to interventions serving HIV-positive persons (PA-08-166). In the U.S., HIV among women is increasing. Women living with HIV (WLH) face tremendous challenges, including: a) making decisions about disclosing their HIV status;and b) negotiating for and practicing safer sexual behavior. Although the Healthy Relationship (HR) intervention was developed to address these challenges, two substantial needs remain. First, there is a need for HR to better address the above described gender specific needs of WLH. Second, there is a need for more widespread dissemination to WLH. Although HR is disseminated in the US by CDC's Dissemination of Effective Behavioral Interventions (DEBI) project, dissemination is limited to geographical areas in which a critical mass of people with HIV can meet in a single location to participate, and where community agencies have the time and resources for these efforts. As such, the proposed R34 study is designed to pilot and feasibility test video group dissemination of an adapted, gender-specific version of Healthy Relationships (HR) for WLH. Our team is currently funded to work with a Community Advisory Board (CAB) to adapt HR into Healthy Relationships-Web (HR-W) to: a) address women's gender-specific needs;and b) enable more widespread delivery through web-based group videoconferencing accessed at community locations. This proposed study is the critical next step towards determining whether or not it is feasible and effective to disseminate HR-W to WLH. Building upon our current work, specific aims of the proposed study are as follows: 1) Conduct pilot testing of HR-W with WLH and make any necessary adaptations to finalize the manual;and 2) Conduct a small partial cross-over feasibility trial comparing HR-W with a wait-list control (WLC), in preparation for a large randomized controlled trial (RCT).
For Aim 1, we will conduct a single-group pilot test and garner feedback from participants to improve the HR-W manual with assistance from our existing CAB.
For Aim 2, WLH will be randomized into the HR-W (n=35) and WLC (n=35) conditions. HR-W participants will receive the intervention immediately after a baseline assessment. After both conditions complete a 6-month follow-up assessment, WLC participants will cross over to the HR-W condition, receive the intervention, and complete a follow-up 6 months later. In preparation for a large RCT (and R01 application), the overall goals of this project are to establish that it is feasible to provide HR-W through videoconferencing and gather evidence suggesting that HR-W may lead to significant reductions in sexual risk behavior. The long-term goal is to establish effectiveness of HR-W for WLH in urban as well as geographically dispersed, low-prevalence, and resource- poor environments.
The successful dissemination of Healthy Relationships-Web through group videoconferencing accessed at community-located intervention stations will have far-reaching methodological and public health impacts. First, this study will establish the feasibility of online dissemination of an adapted version of Healthy Relationships so that, despite socioeconomic and geographic barriers, many more women living with HIV can benefit from the intervention's social support and skills building components. Second, this study will advance behavioral translation science by contributing significantly to current understandings of disseminating group-based interventions online, thus establishing knowledge that can then be used to adapt and disseminate an array of primary, secondary, and tertiary prevention interventions for a range of public health issues.
|Marhefka, Stephanie L; Buhi, Eric R; Baldwin, Julie et al. (2014) Effectiveness of healthy relationships video-group-A videoconferencing group intervention for women living with HIV: preliminary findings from a randomized controlled trial. Telemed J E Health 20:128-34|
|Marhefka, Stephanie L; Iziduh, Sharon; Fuhrmann, Hollie J et al. (2013) Internet-based video-group delivery of Healthy Relationships--a "prevention with positives" intervention: report on a single group pilot test among women living with HIV. AIDS Care 25:904-9|