The purpose of our proposed study is to develop and test the feasibility and acceptability of the RHANI Wives intervention, a multi-session primary HIV prevention program for at-risk Indian wives. The RHANI Wives intervention will be adapted from HIV-IP, a U.S. women's HIV intervention with demonstrated effectiveness in promoting participants' sexual communication and condom use with main male partners. The project will be conducted in 2 phases. Phase 1 will involve adaptation and refinement of the RHANI Wives model and evaluation tools, based on formative research conducted with the target population and their affiliates, as well as a single cycle involving pilot testing a truncated version of the RHANI Wives model. Phase 2 of the study will involve assessment of the feasibility and acceptability of the RHANI Wives HIV prevention intervention for at-risk Indian wives via a cluster randomized trial conducted with 300 eligible women recruited from 12 neighborhood clusters within a single Mumbai slum community. The evaluation will involve assessment of intervention effects on a proximal likely safer sex-mediating behavior, marital sexual communication, via survey at baseline, posttest (6 weeks post-baseline) and at 3 month follow-up (4.5 months post-baseline), to determine the impact of the intervention versus the control on this variable. Exploratory analyses will be conducted to estimate the effect of the intervention on outcomes necessary for examination in an efficacy trial, women's marital condom use and STI. A process evaluation will also be undertaken to ensure quality control and to document program processes and participant response to program. Findings from this study will be used to support development of an NIH R01 for a larger efficacy trial of the RHANI Wives program.
