Nabila El-Bassel

Major ingredients of fidelity: A review and scientific guide to improving quality of intervention research implementation

Despite the critical role of fidelity and the proliferation of intervention manuals and related measures, no comprehensive, structured guide exists, resulting in definitional confusion, varying interpretations of what constitutes core components, and inconsistent application of methods to ensure fidelity. To improve integration of fidelity criteria into intervention research, this review paper focuses on three aims: 1) to identify, define, and operationalize the key ingredients and components of intervention fidelity; 2) to identify consistency and uniformity in terms of core characteristics of fidelity; and, 3) to provide a comprehensive fidelity tool that assesses the core ingredients of fidelity that can be used by researchers to measure the degree of fidelity. Twenty-four (n=24) meta-analyses and review articles focusing on fidelity were identified in a systematic literature search over the past 30 years. A comprehensive review and fidelity guide outlining four required components of intervention research (design, training, monitoring of intervention delivery, and intervention receipt) was developed, with special consideration given to threats and measurement. Fidelity is imperative in all stages and phases of intervention research. This review and guide can be used by practitioners and researchers in their scientific process of designing and implementing community-based psychological, social, and behavioral intervention research.

The Efficacy of a Relationship-Based HIV/STD Prevention Program for Heterosexual Couples

OBJECTIVES This study examined the efficacy of a relationship-based HIV/sexually transmitted disease prevention program for heterosexual couples and whether it is more effective when delivered to the couple or to the woman alone. METHODS Couples (n = 217) were recruited and randomized to (1) 6 sessions provided to couples together (n = 81), (2) the same intervention provided to the woman alone (n = 73), or (3) a 1-session control condition provided to the woman alone (n = 63). RESULTS The intervention was effective in reducing the proportion of unprotected and increasing the proportion of protected sexual acts. No significant differences in effects were observed between couples receiving the intervention together and those in which the woman received it alone. CONCLUSIONS This study demonstrates the efficacy of a relationship-based prevention program for couples at risk for HIV infection.

Couple-focused support to improve HIV medication adherence: a randomized controlled trial.

Objective:To assess the efficacy of a couple-based intervention to improve medication-taking behavior in a clinic population with demonstrated adherence problems. Design:A randomized controlled trial (SMART Couples Study) conducted between August 2000 and January 2004. Setting:Two HIV/AIDS outpatient clinics in New York City. Participants:Heterosexual and homosexual HIV-serodiscordant couples (n = 215) in which the HIV-seropositive partner had < 80% adherence at baseline. The sample was predominantly lower-income racial/ethnic minorities. Intervention:Participants were randomly assigned to a four-session couple-focused adherence intervention or usual care. The intervention consisted of education about treatment and adherence, identifying adherence barriers, developing communication and problem-solving strategies, optimizing partner support, and building confidence for optimal adherence. Outcome measures:Medication adherence at week 8 (2 weeks after the intervention) compared with baseline, assessed with a Medication Event Monitoring System cap. Results:Intervention participants showed higher mean medication adherence at post-intervention when compared with controls whether adherence was defined as proportion of prescribed doses taken (76% versus 60%) or doses taken within specified time parameters (58% versus 35%). Also, participants in the intervention arm were significantly more likely to achieve high levels of adherence (> 80%, > 90%, or > 95%) when compared with controls. However, in most cases, effects diminished with time, as seen at follow-up at 3 and 6 months. Conclusion:The SMART Couples program significantly improved medication adherence over usual care, although the level of improved adherence, for many participants, was still suboptimal and the effect was attenuated over time.

Relationship Between Drug Abuse and Intimate Partner Violence: A Longitudinal Study Among Women Receiving Methadone

OBJECTIVES We examined whether frequent drug use increases the likelihood of subsequent sexual or physical intimate partner violence (IPV) and whether IPV increases the likelihood of subsequent frequent drug use. METHODS A random sample of 416 women on methadone was assessed at baseline (wave 1) and at 6 months (wave 2), and 12 months (wave 3) following the initial assessment. Propensity score matching and multiple logistic regression were employed. RESULTS Women who reported frequent crack use at wave 2 were more likely than non-drug using women to report IPV at wave 3 (odds ratio [OR]=4.4; 95% confidence interval [CI]=2.1, 9.1; P<.01), and frequent marijuana users at wave 2 were more likely than non-drug users to report IPV at wave 3 (OR=4.5; 95% CI=2.4, 8.4; P<.01). In addition, women who reported IPV at wave 2 were more likely than women who did not report IPV to indicate frequent heroin use at wave 3 (OR=2.7; 95% CI=1.1, 6.5; P=.04). CONCLUSIONS Our findings suggest that the relationship between frequent drug use and IPV is bidirectional and varies by type of drug.

Intimate partner violence and HIV risk among urban minority women in primary health care settings

This study describes the associations between intimate partner violence (IPV) and HIV risk among urban, predominantly minority women. Interviews were conducted with 1,590 women, predominantly African American and Latina, attending hospital-based health care clinics. Approximately 1 in 5 women reported experiencing IPV in their current primary heterosexual relationships; about 1 in 8 women reported experiencing IPV in the preceding 6 months. Compared to women who reported no IPV in their primary relationships, women reporting past or current IPV perpetrated by their primary partners were more likely to report having multiple sexual partners, a past or current sexually transmitted infection (STI), inconsistent use or nonuse of condoms, and a partner with known HIV risk factors. These findings indicate that urban minority women experiencing IPV are at elevated risk for HIV infection, results that carry important implications in the efforts to improve HIV and IPV risk assessment protocols and intervention/prevention strategies for women in primary health care settings.

Social Support and Disclosure of Abuse: Comparing South Asian, African American, and Hispanic Battered Women

Sixty-two battered women who had accessed domestic violence services were asked to whom they disclosed the partner abuse, the responses they received, and how supported they felt by kin and nonkin network members. The findings showed that older women and those who had resided in the United States longer were more likely to make disclosures to kin members. Older women, those who had higher levels of perceived social support, and those who reported lower frequency of physical violence were more likely to disclose to nonkin members. The findings suggest that those women experiencing more severe abuse may be the least likely to disclose to others. As a group, the South Asian women were older and more educated, and greater proportions were or had been married to the abuser. In contrast to the other groups, a greater proportion reported having been burned or scalded and fewer reported being sexually coerced. In greater proportions, they disclosed the abuse to brothers and fathers and were advised to stay in their marriages. Service providers working with minority battered women must be knowledgeable of cross-cultural differences in the experience of abuse and disclosure patterns. Culturally appropriate and aggressive outreach within specific ethnic communities may be required to reach battered women in the community. Service providers must consider working with members of womens informal support network to provide both emotional and instrumental support.

Drug abuse and partner violence among women in methadone treatment

This study aims to (1) describe rates of lifetime and current partner abuse among women on methadone; (2) examine the relationship between partner violence and demographics, substance abuse, and drug risk behaviors; and (3) explore the association between a victims current use of crack/cocaine, heroin, marijuana, and drug risk behavior after controlling for demographics, household composition, history of victimization and sex trading. Approximately three-fourths of the women ever experienced physical, sexual, or life-threatening abuse and slightly less than one-third experienced at least one type of abuse during the previous year. A history of childhood victimization was reported by more than half of the women and one-third witnessed her mother being abused. Risk of partner violence was associated with victims current drug and alcohol use, visiting shooting galleries, and living with someone with drug or alcohol problems. The study discusses the implications of the findings for research and intervention.

Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department.

This study examines the relationship between partner violence and sexual risk behaviors in a sample of predominantly Latina and African American women who sought medical care from a New York City hospital emergency department. Eligibility criteria selected women between the ages of 18 and 55, who were sexually active in the past 90 days, and were triaged to nonemergency care. The interview addressed demographics, partner violence, childhood abuse, sexual behavior, and drug and alcohol use. Multiple logistic regression analysis was used to assess the association between partner violence and history of having a sexually transmitted disease (STD) and of having sex with a risky partner. Nearly one half of the 143 respondents (46.1 %, n = 66) reported that they had experienced physical, sexual, or life-threatening abuse by a boyfriend or spouse in the past and 17.5% reported that abuse had occurred within the past year. In the univariate analyses, abused women were more likely than nonabused women to report having had an STD; engaging in sex with a risky partner; having more than one sexual partner; and being tested for HIV. After controlling for confounding variables, abused women were almost five times more likely than their counterparts to have reported an STD and four times more likely to engage in sex with a risky sexual partner. The relationship between partner violence and sexual risk behaviors among women seeking treatment in an emergency department suggests the need for the development of HIV-risk reduction strategies that address the needs of women in abusive relationships.

Building skills of recovering women drug users to reduce heterosexual AIDS transmission

Although most women infected with HIV are intravenous drug users, some contact the virus through sexual contact with IV drug users. To reach at-risk women, public health officials must develop a range of prevention strategies. One approach, skills training, holds promise as a means of altering risk-related sexual behavior. In this study, 91 women methadone patients were pretested and randomly assigned to an information-only control control group or a skills-building intervention group. Skills-building intervention consisted of five sessions of small groups in which participants identified their own high risk sexual behaviors, discussed their negative associations with condoms, and practiced skills which involved asking partners to use condoms. Compared with members of the control group, respondents in the intervention group reported that they initiated discussion of sexual issues with their partners more frequently, felt more comfortable talking with them about safer sex, and reported using and carrying condoms more frequently. The high rates of attendance and program retention by skills-building participants suggest that such groups may be supportive and useful in the design of risk reduction and drug abuse treatment programs. The modest outcomes of this study underscore the difficulty of altering risk behavior but also serve as a basis for future AIDS prevention studies.

Long-Term Effects of an HIV/STI Sexual Risk Reduction Intervention for Heterosexual Couples

This randomized clinical trial examined the relative efficacy of a relationship-based HIV/STI prevention intervention for women and their regular male sexual partners at 12 months post-intervention. A total of 217 couples were randomized to (1) a six-session intervention provided to the woman and her sexual partner together (n = 81); (2) the same intervention provided to the woman alone (n = 73); or (3) a one-session health information education “control” provided to the woman alone (n = 63). Findings suggest the intervention was efficacious in reducing unprotected sex at 12 months post-intervention, compared with the education control group. No significant differences were observed when comparing whether couples received the intervention together or when the woman received it alone.