Individual-level Interventions Research Articles

Public health nursing interventions to promote quality of life in older adult populations: A systematic review

This review analyzes how nurse-led public health interventions promote quality of life (QoL) among older populations. Using Medline and Cinahl databases, authors completed a systematic review of experimental and quasi-experimental studies published between January 2010 and March 2016 that described interventions used by public health nurses to address health needs of older adult populations. Lawton’s theoretical QoL concepts and the Public Health Intervention Wheel model, which names interventions at the individual, community and systems levels, were used to interpret results. The 23 studies were widely distributed geographically. Four of Lawton’s theoretical QoL domains (Health, Functional Health, Personal Competency, Psychological Well-Being) were addressed in the majority of studies. Although public health nurses used Wheel interventions at all levels of practice, individual level interventions were featured in studies to a greater extent in comparison to community and systems level interventions. Few studies used QoL measures to determine intervention effectiveness. Nurses should consider QoL domains, as they design individual, community, and systems level interventions to improve the health of older adult populations.

Knowledge and Beliefs About Biospecimen Research Among Chinese Older Women in Chicago's Chinatown.

Enhancing the participation of Chinese older women in biobanking efforts is important for precision medicine efforts, as underrepresented groups risk benefiting less than others from medical advancements in individualized therapies. Focusing on a sample of Chinese older women in Chicago's Chinatown, this qualitative study seeks to describe attitudes toward, and barriers and facilitators of, participation in biospecimen research. We conducted six focus groups among Chinese-speaking adult women age 45 and above. Focus groups were transcribed, coded, and analyzed for emergent themes. Forty-seven women participated in focus groups, the majority (66.0%) were age 66 and over and half (50.1%) had less than a high school education. Participants expressed predominantly positive attitudes toward biospecimen research, but also identified multifaceted barriers to participation that included cultural beliefs of the body, perceived physical and privacy risks, as well as perceptions related to aging. Use of minimally invasive biospecimen collection and education to promote awareness of biospecimen research were suggested facilitators to increasing biospecimen research participation. Culturally and linguistically isolated populations like Chinese older women are at risk of exclusion from advancements in precision medicine. Our findings provide cultural insights for tailoring interventions for Chinese older women to increase knowledge, change attitudes, and increase intention and participation in biospecimen research. We also highlight the need for individual, family, and community level interventions to promote healthy aging among Chinese older women.

Tobacco smoking: Health impact, prevalence, correlates and interventions

Background and objectives: Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death worldwide. This paper reviews the extent and nature of harms caused by smoking, the benefits of stopping, patterns of smoking, psychological, pharmacological and social factors that contribute to uptake and maintenance of smoking, the effectiveness of population and individual level interventions aimed at combatting tobacco smoking, and the effectiveness of methods used to reduce the harm caused by continued use of tobacco or nicotine in some form.Results and conclusions: Smoking behaviour is maintained primarily by the positive and negative reinforcing properties of nicotine delivered rapidly in a way that is affordable and palatable, with the negative health consequences mostly being sufficiently uncertain and distant in time not to create sufficient immediate concern to deter the behaviour. Raising immediate concerns about smoking by tax increases, social marketing and brief advice from health professionals can increase the rate at which smokers try to stop. Providing behavioural and pharmacological support can improve the rate at which those quit attempts succeed. Implementing national programmes containing these components are effective in reducing tobacco smoking prevalence and reducing smoking-related death and disease.

Sexually Objectifying Environments

In this study, we investigated the relations between sexually objectifying restaurant environments (SOREs) and anxiety and disordered eating in a sample of 252 waitresses working in restaurants located in the United States. Supporting our hypotheses, results indicated that higher levels of SOREs were positively correlated with waitresses’ anxiety and disordered eating. Our findings also supported a theorized four-chain mediation model in which higher levels of SOREs were related to both anxiety and disordered eating directly and indirectly via, in serial: less organizational power, less personal power and control, and more rumination. In addition, SOREs and a lack of organizational power had direct, unique links to rumination. Our findings highlight the importance of both contextual and intrapersonal factors in understanding waitresses’ mental health problems. These findings underscore the need to implement both system-level and individual-level interventions to combat the existence of SOREs and the negative effects these environments may have on women who work in the industry. Online slides for instructors who want to use this article for teaching are available on PWQ 's website at http://journals.sagepub.com/page/pwq/suppl/index

Categorical and anti-categorical approaches to US racial/ethnic groupings: revisiting the National 2009 H1N1 Flu Survey (NHFS)

Intersectionality theory calls for the understanding of race/ethnicity, sex/gender and class as interlinked. Intersectional analysis can contribute to public health both through furthering understanding of power dynamics causing health disparities, and by pointing to heterogeneities within, and overlap between, social groups. The latter places the usefulness of social categories in public health under scrutiny. Drawing on McCall we relate the first approach to categorical and the second to anti-categorical intersectionality. Here, we juxtapose the categorical approach with traditional between-group risk calculations (e.g. odds ratios) and the anti-categorical approach with the statistical concept of discriminatory accuracy (DA), which is routinely used to evaluate disease markers in epidemiology. To demonstrate the salience of this distinction, we use the example of racial/ethnic identification and its value for predicting influenza vaccine uptake compared to other conceivable ways of organizing attention to social differentiation. We analyzed data on 56,434 adults who responded to the NHFS. We performed logistic regressions to estimate odds ratios and computed the area under the receiver operating characteristic curve (AU-ROC) to measure DA. Above age, the most informative variables were education and household poverty status, with race/ethnicity providing minor additional information. Our results show that the practical value of standard racial/ethnic categories for making inferences about vaccination status is questionable, because of the high degree of outcome variability within, and overlap between, categories. We argue that, reminiscent of potential tension between categorical and anti-categorical perspectives, between-group risk should be placed and understood in relationship to measures of DA, to avoid the lure of misguided individual-level interventions.

Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low- and Middle-Income Countries: A Review of the Evidence.

Female sex workers and other women at high risk of acquiring HIV have the right to sexual and reproductive health, including the right to determine the number and timing of pregnancies. We conducted a literature review to examine the data that exist regarding the family planning and reproductive health needs of female key populations, the underlying determinants of these populations' vulnerability to poor reproductive health outcomes, and the obstacles they face in accessing high-quality reproductive health services. Findings indicate that female key populations experience high rates of unmet need for family planning and safer conception services, unintended pregnancies, sexual violence, and abortion, and that they practice inconsistent condom use. Restrictive policy environments, stigma and discrimination in health care settings, gender inequality, and economic marginalization restrict access to services and undermine the ability to safely achieve reproductive intentions. We offer recommendations for structural, health system, community, and individual-level interventions that can mitigate the effects of these barriers and improve reproductive health outcomes.

Teaching Girls About Puberty and Menstrual Hygiene Management in Rural Ethiopia: Findings From a Pilot Evaluation

Educational interventions on menstruation and puberty have emerged as an important element of efforts to improve girls’ knowledge and confidence related to puberty, menstruation, and menstrual hygiene management (MHM). We conducted a mixed-methods evaluation of the Ethiopia Growth and Changes puberty book, developed through research with Ethiopian girls to present scientifically accurate content on MHM in a format appropriate to girls’ lives. Deploying a cluster-randomized approach, we conducted quantitative surveys with girls enrolled in Grades 6 and 7 ( n = 636) in 10 intervention and 10 control schools in two rural districts of the West Shewa Zone of Oromia, Ethiopia. We collected qualitative data from girls in intervention schools. We found that the book was associated with a statistically significant improvement in knowledge, and evidence of improvements in attitudes around menstruation. Qualitative evidence underscored a strong interest in interventions that present information on menstruation and puberty in accurate and supportive terms. Consistent with an ecological framework for adolescent health, we conclude that puberty books offer a useful individual-level intervention, whose impact would be magnified if combined with investments aimed at creating more gender equitable physical and social school environments.

Babies Living Safe & Smokefree: randomized controlled trial of a multilevel multimodal behavioral intervention to reduce low-income children\u2019s tobacco smoke exposure

BackgroundAddressing children’s tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations.Methods/DesignThis trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the “Ask, Advise, Refer (AAR)” best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline.DiscussionThis study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.Trial registrationClinicaltrials.gov NCT02602288. Registered 9 November 2015.

Human papillomavirus (HPV) vaccine initiation in minority Americans

ObjectivesTransmission of the human papillomavirus (HPV) is a significant public health concern. HPV is preventable through a series of vaccinations; however, knowledge gaps exist as to which groups are least likely to initiate vaccination. Considering this gap, the aim of this study is to examine HPV vaccine initiation rates in racial minorities, comparing foreign-born individuals to their American-born peers. Study designPopulation-based data from the 2013 National Health Interview Survey (NHIS), a repeated large-scale household interview survey of a statistically representative sample of the United States civilian non-institutionalized population, were applied. Data were derived from two survey modules: the family and summary adult modules. MethodsSampling weights were employed to logistic regression modelling the outcome of HPV vaccine initiation. ResultsForeign-born persons, African Americans, males, those lacking health insurance coverage and those without a medical home (usual place to receive care) held statistically lower rates of HPV vaccine initiation. Being college educated was associated with higher odds of HPV vaccine initiation. ConclusionsOur findings support the persistence of health disparities in racial minorities and foreign-born persons residing in the United States. Addressing these gaps will likely require both individual-level (e.g. targeted health education) and system-level (e.g. HPV vaccine promoting policies) interventions. Since health insurance coverage and having a medical home were significant associates of HPV vaccine initiation, attempts to coverage may improve HPV vaccine initiation rates. Additionally, policies which require HPV vaccination for school entry could boost coverage across all population groups, including boys, foreign-born persons and racial minorities.

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development.

Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. The study is registered as PROSPERO CRD42014009500. The National Institute for Health Research Health Technology Assessment programme.

Modelo de atención psicológica para mujeres víctimas de violencia familiar albergadas en hogares de refugios temporal. HRT.

Homes in temporary shelter should contribute to the emotional recovery of victims of violence and a change or modification of behavior based on the establishment of healthy relationships, promoting their autonomy and recognition of their abilities. The psychological recovery of women victims of violence is critical to feeling person and woman, with rights and values that must be protected, only then can start a dignified, independent and free life. At the same time, recovery is invaluable for improving quality healthy family context. Emerging shelter homes, Basic Principles on the psychological intervention for women housed in HRT, considerations related to the emotional state of women victims of domestic violence and Good professional practices: Considering these aspects in this article discusses the following topics are developed. Finally, the proposed model describes psychological care from both the individual level intervention that includes crisis intervention and counseling; also considering the group level from a psychoeducational approach.

Towards a new model of evidence for public health

BackgroundWe are faced with a growing crisis of non-communicable diseases driven by factors such as unhealthy diets, physical inactivity, tobacco use, and alcohol consumption, compounded by major inequalities in health. Over recent decades, biomedical research methods have helped to answer many important questions about treatment and prevention, but the kinds of tools that can tell us which intervention to choose over another are not invariably the most appropriate to address complex challenges such as designing healthier cities, or creating healthier, more sustainable food systems. The aim of this project was to identify the main obstacles to obtaining valid and appropriate evidence to guide public health decision making, and propose a set of solutions to address these problems. MethodsWe conducted a series of case studies to illustrate some of the problems with the current dominance of the biomedical approach to the generation and use of evidence for complex public health problems, including an analysis of the types of projects funded by the National Institute for Health Research (NIHR) Public Health Research (PHR) Programme since 2009. We held a workshop on Sept 12–13, 2016, for several internationally recognised experts on complex systems approaches to public health evidence to produce a consensus statement. FindingsThe NIHR case study showed that funding from the PHR Programme has predominantly gone to the evaluation of downstream, individual-level interventions, with only a small proportion devoted to assessment of upstream policy actions (>75% of the 110 funded proposals examined downstream or midstream interventions). The key conclusions from the meeting are that current approaches to research and policy in major public health problems such as obesity have reached an impasse. Breaking this impasse will require a move beyond linear models of cause and effect to embrace complex systems approaches to both the generation and use of evidence. Achieving a solution will require many changes, ranging from strategic shifts in the way research is funded to new conceptual models for tackling public health problems at system level. InterpretationThere is a pressing need to change the focus of research and action to tackle complex public health problems. Research funding must address the challenges of evaluating not only complex interventions, but also simple interventions within complex systems. The tools required to do this are still in the early stages of development, but we need to rebalance our approach to public health research to encompass complex systems science and methods in addition to more traditional biomedical approaches. The expert group will publish its views in a consensus paper towards the end of 2016. FundingThis work is supported by a grant from The Health Foundation.

Context and Scope of Social Work Interventions in Perinatal Mental Health Settings in India

The perinatal period may not be a happy time for all mothers. During this period, some may develop psychiatric complications, which have both biological and psychosocial etiology, and such illness may affect the whole family. Psychosocial aspects may trigger the illness and act as risk and maintaining factors. Social workers need to intervene in this context for optimal functioning of women with perinatal mental health issues and her family. A biopsychosocial framework may be adopted for social work assessment and intervention. Individual, familial, group, and community level intervention is required to address this complex issue, along with other mental health clinicians.

Neighborhood factors and six-month weight change among overweight individuals in a weight loss intervention.

The purpose of this study was to examine the neighborhood environment and the association with weight change among overweight/obese individuals in the first six months of a 12-month weight loss intervention, EMPOWER, from 2011 to 2015. Measures of the neighborhood environment included neighborhood racial composition, neighborhood income, and neighborhood food retail stores density (e.g., grocery stores). Weight was measured at baseline and 6 months and calculated as the percent weight change from baseline to 6 months. The analytic sample (N = 127) was 91% female and 81% white with a mean age of 51 (± 10.4) years. At 6 months, the mean weight loss was 8.0 kg (± 5.7), which was equivalent to 8.8% (± 6%) of baseline weight. Participants living in neighborhoods in which 25–75% of the residents identified as black had the greatest percentage of weight loss compared to those living in neighborhoods with < 25% or > 75% black residents. No other neighborhood measures were associated with weight loss. Future studies testing individual-level behavioral weight loss interventions need to consider the influence of neighborhood factors, and how neighborhood-level interventions could be enhanced with individual-level interventions that address behaviors and lifestyle changes.

Organizational Initiatives for Promoting Employee Work-Life Reconciliation Over the Life Course. A Systematic Review of Intervention Studies

This review aimed to explore the initiatives, interventions, and experiments implemented by employing organizations and designed to support the work-life reconciliation at workplaces, and the effects of these actions on employees’ well-being at work. A systematic literature review was conducted on the basis of a search in PsycInfo, ERIC, and the ISI Web of Science database of Social Sciences between January 2000 and May 2015. Those studies were included in which either organizational or individual-level initiatives, interventions, or experiments were implemented by employers at workplaces in order to promote the work-life reconciliation of their employees. Work-life reconciliation was considered to encompass all life domains and all career stages from early to the end of working career. The content analysis of 11 studies showed that effective employer actions focused on working time, care arrangements, and training for supervisors and employees. Flexibility, in terms of both working time and other arrangements provided for employees, and support from supervisors decreased work-family conflict, improved physical health and job satisfaction, and also reduced the number of absence days and turnover intentions. Overall, very few intervention studies exist investigating the effects of employer-induced work-life initiatives. One should particularly note the conditions under which interventions are most successful, since many contextual and individual-level factors influence the effects of organizational initiatives on employee and organizational outcomes.

Antecedents and consequences of perceived knowledge update in the context of an ERP simulation game: A multi-level perspective

Researchers and practitioners have encouraged the use of simulation games as a means of training for enhancing users' IT knowledge. However, prior research on IT knowledge has not paid much attention as to how individuals’ perceptions of knowledge shift from the pre-training to the post-training state, and has focused mainly on individual-level interventions. Drawing on the theoretical foundation of belief and attitude change, this study examines the construct of perceived knowledge update (i.e., the difference between perceived post-training knowledge and perceived pre-training knowledge) and its antecedents and consequences. In particular, we examine team collaboration effectiveness at the team level and participant effort at the individual level as predictors of perceived ERP knowledge update, which then influences intention to learn about ERP systems. We tested our research model using 252 students in 85 teams in the context of an ERP (Enterprise Resource Planning) simulation game. ERP systems are a business process management software which allows an organization to utilize a system of integrated applications. ERP simulation games are designed to educate ERP system users on the complexities of such systems. Our results show that team collaboration effectiveness positively influences individual effort and perceived knowledge update. We also provide empirical evidence that individual effort positively affects perceived knowledge update which in turn influences intention to learn about ERP systems.

A soft pillow for hard times? Economic insecurity, food intake and body weight in Russia

This study investigates causal effects of economic insecurity on subjective anxiety, food intake, and weight outcomes. A review of psychological and nutrition studies highlights the complexity of processes at work on each stage of this causal chain. Econometric analyses trace the effects along the hypothesized pathway using detailed household panel data from the Russia Longitudinal Monitoring Survey from 1994 to 2005. Economic insecurity measures serve as key explanatory variables in regressions and are instrumented by exogenous regional indicators. Results support a causal chain from economic insecurity to weight outcomes for some population subgroups. In contrast to the leading hypothesis that economic insecurity increases body weight, I find strong evidence of a decreasing effect among women. Results suggest further that consumption of foods rich in sugar responds strongly to higher levels of economic insecurity. Heterogeneous impacts of economic insecurity on body weight call for individual-level interventions rather than large-scale action.

Interventions to improve treatment, retention and survival outcomes for adolescents with perinatal HIV-1 transitioning to adult care: moving on up.

There is an increasing number of deaths among adult survivors of perinatal HIV. Multiple and complex factors drive this mortality, including problems with retention in care and adherence during adolescence, coupled with the critical period of transition from paediatric to adult care, increasing their risk of treatment failure and severe immunosuppression. We reviewed studies that evaluated the impact of service delivery interventions to improve the health of perinatally infected adolescents living with HIV (P-ALHIV) to gain insight into what might help them survive the vulnerable period of adolescence. Youth-focused health services and individual-level interventions may improve P-ALHIV adherence and retention in care. However, there have been few studies, many with small sample sizes and with short durations of follow-up that end before the transition period. Studies from other childhood-onset chronic diseases are similarly limited. Further studies are urgently needed to identify optimal intervention strategies to reduce mortality and poor outcomes as the adolescent population expands and ages into adult care. Until we have a more robust evidence base, programmes can develop transition plans based on best practice recommendations to optimize the health and longevity of ALHIV in adulthood.

The Effect of a Multi-Level Intervention on the Initiation of Antiretroviral Therapy (ART) among HIV-Infected Men Who Inject Drugs and Were Diagnosed Late in Thai Nguyen, Vietnam.

BackgroundIn Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART.MethodsWe investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a non-parametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013.FindingsBy 24-months, 61.0% initiated ART, and 30.9% had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28% (95% confidence interval (CI): 6–50%) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31% (95% CI: 5–56%) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together.ConclusionsMarginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART.

A Dyadic Behavioral Intervention to Optimize Same Sex Male Couples' Engagement Across the HIV Care Continuum: Development of and Protocol for an Innovative Couples-based Approach (Partner Steps).

BackgroundAn estimated one- to two-thirds of new human immunodeficiency virus (HIV) infections among US men who have sex with men (MSM) occur within the context of primary partnerships. Thus, HIV interventions that recognize and harness the power of relationships are needed. Increasingly, HIV prevention efforts are being directed toward improving engagement across the HIV care continuum from testing to linkage to care, antiretroviral therapy (ART) adherence, engagement in care, and viral suppression. However, to our knowledge, no behavioral interventions have attempted to address the HIV care continuum using a dyadic approach.ObjectiveThe objective of this paper is to describe the development of and protocol for an innovative couples-based approach to improving treatment adherence and engagement in care among HIV serodiscordant and concordant HIV-positive same sex male couples in the United States.MethodsWe developed the Partner Steps intervention by drawing from relationship-oriented theory, existing efficacious individual-level ART adherence interventions, couple-focused HIV prevention interventions, and expert consultation. We incorporated new content to address all aspects of the HIV care continuum (eg, linkage to and retention in care) and to draw on relationship strengths through interactive activities.ResultsThe resulting theory-based Partner Steps intervention is delivered by a trained bachelors-level counselor (interventionist) over 2 in-person sessions with male-male dyads in which at least 1 partner has recent suboptimal engagement in HIV care. Each session is designed to use relationship strengths to increase motivation for HIV care and treatment, and cover sequential intervention “steps” relating to specific challenges in HIV care engagement and barriers to ART adherence. For each step, couples work with a trained interventionist to identify their unique challenges, actively problem-solve with the interventionist, and articulate and commit to working together to implement a plan in which each partner agrees to complete specific tasks.ConclusionsWe drew on theory and evidence to develop novel intervention strategies that leverage strengths of relationships to address engagement across the entire HIV care continuum. We provide details on intervention development and content that may be of use to researchers as well as medical and mental health professionals for whom a dyadic approach to HIV prevention and care may best suit their patient population.