Marhefka Stephanie L, Buhi Eric R, Baldwin Julie, Chen Henian, Johnson Ayesha, Lynn Vickie, Glueckauf Robert
1 Department of Community and Family Health, College of Public Health, University of South Florida , Tampa, Florida.
Telemed J E Health. 2014 Feb;20(2):128-34. doi: 10.1089/tmj.2013.0072. Epub 2013 Nov 16.
Expanded access to efficacious interventions is needed for women living with human immunodeficiency virus (WLH) in the United States. Availability of "prevention with (human immunodeficiency virus [HIV)] positives" interventions in rural/remote and low HIV prevalence areas remains limited, leaving WLH in these communities few options for receiving effective behavioral interventions such as Healthy Relationships (HR). Offering such programs via videoconferencing groups (VGs) may expand access. This analysis tests the effectiveness of HR-VG (versus wait-list control) for reducing sexual risk behavior among WLH and explores intervention satisfaction.
In this randomized controlled trial unprotected vaginal/anal sex occasions over the prior 3 months reported at the 6-month follow-up were compared across randomization groups through zero-inflated Poisson regression modeling, controlling for unprotected sex at baseline. Seventy-one WLH were randomized and completed the baseline assessment (n=36 intervention and n=35 control); 59 (83% in each group) had follow-up data.
Among those who engaged in unprotected sex at 6-month follow-up, intervention participants had approximately seven fewer unprotected occasions than control participants (95% confidence interval 5.43-7.43). Intervention participants reported high levels of satisfaction with HR-VG; 84% reported being "very satisfied" overall.
This study found promising evidence for effective dissemination of HIV risk reduction interventions via VGs. Important next steps will be to determine whether VGs are effective with other subpopulations of people living with HIV (i.e., men and non-English speakers) and to assess cost-effectiveness. Possibilities for using VGs to expand access to other psychosocial and behavioral interventions and reduce stigma are discussed.
美国感染人类免疫缺陷病毒(HIV)的女性需要更广泛地获得有效的干预措施。在农村/偏远地区和HIV低流行地区,“HIV阳性者预防”干预措施的可及性仍然有限,使得这些社区的感染HIV的女性获得诸如健康关系(HR)等有效行为干预的选择很少。通过视频会议小组(VG)提供此类项目可能会扩大可及性。本分析测试了HR-VG(与等待名单对照相比)在降低感染HIV的女性的性风险行为方面的有效性,并探讨了干预满意度。
在这项随机对照试验中,通过零膨胀泊松回归模型比较了随机分组在6个月随访时报告的前3个月无保护阴道/肛交次数,并控制了基线时的无保护性行为。71名感染HIV的女性被随机分组并完成了基线评估(n = 36干预组和n = 35对照组);59名(每组83%)有随访数据。
在6个月随访时进行无保护性行为的人群中,干预组参与者的无保护性行为次数比对照组参与者大约少7次(95%置信区间5.43 - 7.43)。干预组参与者对HR-VG的满意度很高;84%的人报告总体“非常满意”。
本研究发现了通过视频会议小组有效传播HIV风险降低干预措施的有前景的证据。接下来重要的步骤将是确定视频会议小组对其他HIV感染者亚人群(即男性和非英语使用者)是否有效,并评估成本效益。还讨论了使用视频会议小组扩大获得其他心理社会和行为干预措施以及减少耻辱感的可能性。