The HIV/AIDS epidemic continues to be a major public health concern that has hit African Americans particularly hard. Individual-level prevention approaches, although effective, are too narrowly focused and ignore the role relationships play in HIV/STD transmission. Couple-level interventions, especially with serodiscordant couples, redirect the focus to changing the relationship factors that influence sexual decision-making and increase the likelihood that sexual risk reduction will be stable over time. This U10 competing continuation application seeks four additional years of support to meet the original plan to enroll 800 African American HIV serodiscordant couples into Project Eban, the NIMH Multisite HIV/STD Prevention Trial for African American Couples, that is being conducted in four clinical sites-Atlanta, Los Angeles, New York, and Philadelphia-in collaboration with the NIMH and a Data Coordinating Center. Although attendance rates at intervention sessions and retention rates at follow-up assessments have been excellent, recruitment challenges have caused slower couple enrollment than was originally planned. Additional time is needed to implement new recruitment activities that are anticipated to recruit these hard-to-reach couples. As in the original trial, we will randomize couples to (1) an 8-session couples-focused HIV/STD Risk Reduction Intervention or (2) an 8-session individual-focused Health Promotion Intervention (the comparison condition) that addresses health issues unrelated to sexual behavior. Both interventions involve couple and group sessions led by trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, an Afro centric paradigm and the applicant teams' previous work with African American populations. The primary behavioral outcome is self-reported proportion of condom- protected sexual intercourse; the primary biological outcome is the incidence of STDs (i.e., chlamydia, gonorrhea, and trichomonas) assessed by DNA amplification tests on urine and vaginal specimens. Secondary outcomes include theoretically relevant variables hypothesized to mediate and moderate intervention effects. Audio computer-assisted self-interviewing (ACASI) will be used to collect data at baseline, immediately post-intervention, and at 6- and 12-month follow-up. Generalized estimating equations (GEE) and mixed-effects modeling (MEM) will be used to test (1) the effects of the intervention on STD incidence and condom use as well as on mediator variables of these outcomes and (2) whether the effects of the intervention differ depending on key moderator variables (e.g., gender of the seropositive partner, length of relationship, psychological distress, sexual abuse history, and substance abuse history. The findings will contribute significantly to an understanding of HIV/STD risk reduction among African American serodiscordant couples, a population at high risk of transmission. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Cooperative Clinical Research--Cooperative Agreements (U10)
Project #
2U10MH064394-06
Application #
7167674
Study Section
Special Emphasis Panel (ZMH1-ERB-D (06))
Program Officer
Gordon, Christopher M
Project Start
2002-04-01
Project End
2009-03-31
Budget Start
2007-02-02
Budget End
2007-11-30
Support Year
6
Fiscal Year
2007
Total Cost
$962,444
Indirect Cost
Name
University of Pennsylvania
Department
Type
Other Domestic Higher Education
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
El-Bassel, Nabila; Jemmott 3rd, John B; Landis, J Richard et al. (2011) Intervention to influence behaviors linked to risk of chronic diseases: a multisite randomized controlled trial with African-American HIV-serodiscordant heterosexual couples. Arch Intern Med 171:728-36
El-Bassel, Nabila; Jemmott, John B; Landis, J Richard et al. (2010) National Institute of Mental Health Multisite Eban HIV/STD Prevention Intervention for African American HIV Serodiscordant Couples: a cluster randomized trial. Arch Intern Med 170:1594-601
NIMH Multisite HIV/STD Prevention Trial for African American Couples Group (2010) Risky sexual behavior and correlates of STD prevalence among African American HIV serodiscordant couples. AIDS Behav 14:1023-31
NIMH Multisite HIV/STD Prevention Trial for African American Couples Group (2010) Prevalence of child and adult sexual abuse and risk taking practices among HIV serodiscordant African-American couples. AIDS Behav 14:1032-44
NIMH Multisite HIV/STD Prevention Trialfor African American Couples Group (2010) The contribution of male and female partners' substance use to sexual risks and STDs among African American HIV serodiscordant couples. AIDS Behav 14:1045-54
NIMH Multisite HIV/STD Prevention Trial for African American Couples Group (2010) Concordant and discordant reports on shared sexual behaviors and condom use among African American serodiscordant couples in four cities. AIDS Behav 14:1011-22
NIMH Multisite HIV/STD Prevention Trial for African American Couples Group (2008) Formative study to develop the Eban treatment and comparison interventions for couples. J Acquir Immune Defic Syndr 49 Suppl 1:S42-51
NIMH Multisite HIV/STD Prevention Trial for African American Couples Group (2008) Eban health promotion intervention: conceptual basis and procedures. J Acquir Immune Defic Syndr 49 Suppl 1:S28-34
Bellamy, Scarlett L; NIMH Multisite HIV/STD Prevention Trial for African American Couples Study Group (2005) A dynamic block-randomization algorithm for group-randomized clinical trials when the composition of blocking factors is not known in advance. Contemp Clin Trials 26:469-79