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Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples

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Abstract

Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention’s effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.

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References

  1. El-Bassel N, Jemmott JB, Landis JR, Pequegnat W, Wingood GM, Wyatt GE, et al. National Institute of Mental Health Multisite Eban HIV/STD prevention intervention for African American HIV serodiscordant couples: a cluster randomized trial. Arch Intern Med. 2010;170(17):1594–601.

    Article  PubMed  PubMed Central  Google Scholar 

  2. O’Leary A, Hoff CC, Purcell DW, Gomez CA, Parsons JT, Hardnett F, et al. What happened in the SUMIT trial? Mediation and behavior change. Aids. 2005;19(Suppl 1):S111–21.

    Article  PubMed  Google Scholar 

  3. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods. 2002;7(1):83–104.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.

    Article  CAS  PubMed  Google Scholar 

  5. O’Leary A, Jemmott LS, Jemmott JB 3rd. Mediation analysis of an effective sexual risk-reduction intervention for women: the importance of self-efficacy. Health Psychol. 2008;27(2 Suppl):S180–4.

    Article  PubMed  Google Scholar 

  6. National Institute of Mental Health Multisite HIV Prevention Trial Group. Social-cognitive theory mediators of behavior change in the National Institute of Mental Health Multisite HIV Prevention Trial. Health Psychol. 2001;20(5):369–76.

    Article  Google Scholar 

  7. O’Leary A, Jemmott JB 3rd, Jemmott LS, Bellamy S, Ngwane Z, Icard L, et al. Moderation and mediation of an effective HIV risk-reduction intervention for South African adolescents. Ann Behav Med. 2012;44(2):181–91.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sales JM, Lang DL, DiClemente RJ, Latham TP, Wingood GM, Hardin JW, et al. The mediating role of partner communication frequency on condom use among African American adolescent females participating in an HIV prevention intervention. Health Psychol. 2012;31(1):63–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sanderson CA, Jemmott JB 3rd. Moderation and mediation of HIV prevention interventions: relationship status, intentions, and condom use among college students. J Appl Soc Psychol. 1996;26:2076–99.

    Article  Google Scholar 

  10. O’Leary A, Jemmott JB III, Jemmott LS, Bellamy S, Icard LD, Ngwane Z. Mediation of an efficacious HIV risk reduction intervention for South African men. AIDS Behav. 2015;19(10):1842–9.

    Article  PubMed  Google Scholar 

  11. Pitpitan EV, Kalichman SC, Garcia RL, Cain D, Eaton LA, Simbayi LC. Mediators of behavior change resulting from a sexual risk reduction intervention for STI patients, Cape Town, South Africa. J Behav Med. 2015;38(2):194–203.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jemmott JB 3rd, Jemmott LS, O’Leary A, Icard LD, Rutledge SE, Stevens R, et al. On the efficacy and mediation of a social cognitive one-on-one HIV risk-reduction intervention for African American men who have sex with men: a randomized controlled trial. AIDS Behav. 2014;19(7):1247–62.

    Article  PubMed Central  Google Scholar 

  13. Zhang J, Jemmott JB, 3rd, Jemmott LS. Mediation and moderation of an efficacious theory-based abstinence-only intervention for African American adolescents. Health Psychol. 2015.

  14. Bandura A. Social foundations of thought and action: A social and cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.

    Google Scholar 

  15. Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman and Company; 1997.

    Google Scholar 

  16. Bronfenbrenner U. The ecology of human development: experiments by nature and design. Cambridge, MA: Harvard University Press; 1979.

    Google Scholar 

  17. Karenga M. Black studies and the problematic of paradigm: the philosophical dimension. J Black Stud. 1988;18:395–414.

    Article  Google Scholar 

  18. O’Leary A, Maibach E, Ambrose TK, Jemmott JB III, Celentano D. Social cognitive predictors of sexual risk behavior among STD clinic patients. AIDS Behav. 2000;4(4):309–16.

    Article  Google Scholar 

  19. Bandura A. Perceived self-efficacy in the exercise of control over AIDS infection. Primary Prevention of AIDS. Newbury Park: Sage; 1989. p. 128–41.

    Google Scholar 

  20. O’Leary A. Self-efficacy and health. Behav Res Ther. 1985;23(4):437–51.

    Article  PubMed  Google Scholar 

  21. Do M, Fu H. Is women’s self-efficacy in negotiating sexual decisionmaking associated with condom use in marital relationships in Vietnam? Stud Fam Plann. 2011;42(4):273–82.

    Article  PubMed  Google Scholar 

  22. Reid AE, Aiken LS. Integration of five health behaviour models: common strengths and unique contributions to understanding condom use. Psychol Health. 2011;26(11):1499–520.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Schutz M, Godin G, Kok G, Vezina-Im LA, Naccache H, Otis J, et al. Determinants of condom use among HIV-positive men who have sex with men. Int J STD AIDS. 2011;22(7):391–7.

    Article  CAS  PubMed  Google Scholar 

  24. Bandura A. Perceived self-efficacy in the exercise of control over AIDS infection. In: Mays VM, Albee GW, Schneider SF, editors. Primary prevention of AIDS: psychological approaches. Newbury Park: Sage; 1989. p. 128–41.

    Google Scholar 

  25. Albarracin D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull. 2001;127(1):142–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Triandis HC. Culture and social behavior. New York: McGraw-Hill; 1994.

    Google Scholar 

  27. El-Bassel N, Witte SS, Gilbert L, Wu E, Chang M, Hill J, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health. 2003;93(6):963–9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wyatt GE. The sociocultural relevance of sex research. Challenges for the 1990s and beyond. Am Psychol. 1994;49(8):748–54.

    Article  CAS  PubMed  Google Scholar 

  29. Akoto K. Nation building: Theory and practice in Afrikan-centered education. Washington, DC: Pan-Afrikan World Institute; 1992.

    Google Scholar 

  30. Grills C. Motivating illegal drug use recovery: evidence for a culturally congruent intervention. J Black Psychol. 2000;26:288–301.

    Article  Google Scholar 

  31. Bellamy SL. A dynamic block-randomization algorithm for group-randomized clinical trials when the composition of blocking factors is not known in advance. Contemp Clin Trials. 2005;26(4):469–79.

    Article  PubMed  Google Scholar 

  32. El-Bassel N, Jemmott JB 3rd, Landis JR, Pequegnat W, Wingood GM, Wyatt GE, et al. 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. 2011;171(8):728–36.

    Article  PubMed  PubMed Central  Google Scholar 

  33. National Institute of Mental Health Multisite HIV/STD Prevention. Trial for African American Couples Group. Eban HIV/STD risk-reduction intervention: conceptual bais and procedures. J Acquir Immune Defic Syndr. 2008;49(Suppl 1):S15–27.

    Google Scholar 

  34. Cook T, Campbell D. Quasi-experimentation: design and analysis for field settings. Chicago: Houghton Mifflin; 1979.

    Google Scholar 

  35. National Institute of Mental Health. (NIMH) Multisite HIV Prevention Trial Group. The NIMH Multisite HIV prevention trial: reducing HIV sexual risk behavior. Science. 1998;280:1889–94.

    Article  Google Scholar 

  36. Morin SF, Shade SB, Steward WT, Carrico AW, Remien RH, Rotheram-Borus MJ, et al. A behavioral intervention reduces HIV transmission risk by promoting sustained serosorting practices among HIV-infected men who have sex with men. J Acquir Immune Defic Syndr. 2008;49(5):544–51.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wingood GM, DiClemente RJ, Mikhail I, Lang DL, McCree DH, Davies SL, et al. A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: the WiLLOW program. J Acquir Immune Defic Syndr. 2004;37(Suppl 2):S58–67.

    Article  PubMed  Google Scholar 

  38. Lawrence JSS, Chapdelaine AP, Devieux JG, O’Bannon RE, Brasfield TL, Eldridge GD. Measuring perceived barriers to condom use: Psychometric evaluation of the Condom Barriers Scale. Assessment. 1999;6(4):391–404.

    Article  Google Scholar 

  39. Jemmott JB 3rd, Jemmott LS, Hacker CI. Predicting intentions to use condoms among African-American adolescents: the theory of planned behavior as a model of HIV risk-associated behavior. Ethn Dis. 1992;2(4):371–80.

    PubMed  Google Scholar 

  40. Jemmott JB 3rd, Jemmott LS, Fong GT. Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial. J Am Med Assoc. 1998;279(19):1529–36.

    Article  Google Scholar 

  41. Villarruel AM, Jemmott JB 3rd, Jemmott LS, Ronis DL. Predictors of sexual intercourse and condom use intentions among Spanish-dominant Latino youth: a test of the planned behavior theory. Nurs Res. 2004;53(3):172–81.

    Article  PubMed  Google Scholar 

  42. Jemmott JB 3rd, Jemmott LS, Braverman PK, Fong GT. HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial. Arch Pediatr Adolesc Med. 2005;159(5):440–9.

    Article  PubMed  Google Scholar 

  43. Heeren GA, Jemmott JB 3rd, Mandeya A, Tyler JC. Sub-Saharan African university students’ beliefs about condoms, condom-use intention, and subsequent condom use: a prospective study. AIDS Behav. 2009;13(2):268–76.

    Article  PubMed  PubMed Central  Google Scholar 

  44. DiClemente RJ, Wingood GM, Harrington KF, Lang DL, Davies SL, Hook EW 3rd, et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA J Am Med Assoc. 2004;292(2):171–9.

    Article  CAS  Google Scholar 

  45. Fishbein M, Ajzen I. Predicting and changing behavior: the reasoned action approach. New York: Taylor and Francis Group; 2010.

    Google Scholar 

  46. Marin BV, Tschann JM, Gomez CA, Gregorich S. Self-efficacy to use condoms in unmarried Latino adults. Am J Community Psychol. 1998;26(1):53–71.

    Article  CAS  PubMed  Google Scholar 

  47. Marin BV, Gomez CA, Tschann JM, Gregorich SE. Condom use in unmarried Latino men: a test of cultural constructs. Health Psychol. 1997;16(5):458–67.

    Article  CAS  PubMed  Google Scholar 

  48. Hendrick SS. A generic measure of relationship satisfaction. J Marriage Fam. 1988;50:93–8.

    Article  Google Scholar 

  49. Sarason IG, Levine HM, Basham RB, Sarason BR. Assessing social support: the social support questionnaire. J Pers Soc Psychol. 1983;44(1):127–39.

    Article  Google Scholar 

  50. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behav Res. 2004;39(1):99–128.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13–22.

    Article  Google Scholar 

  52. Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. New York: Wiley; 2004.

    Google Scholar 

  53. Koniak-Griffin D, Lesser J, Henneman T, Huang R, Huang X, Tello J, et al. HIV prevention for Latino adolescent mothers and their partners. West J Nurs Res. 2008;30(6):724–42.

    Article  PubMed  Google Scholar 

  54. LaCroix JM, Pellowski JA, Lennon CA, Johnson BT. Behavioural interventions to reduce sexual risk for HIV in heterosexual couples: a meta-analysis. Sex Transm Infect. 2013;89(8):620-U103.

    Article  Google Scholar 

  55. Jiwatram-Negron T, El-Bassel N. Systematic review of couple-based HIV intervention and prevention studies: advantages, gaps, and future directions. AIDS Behav. 2014;18(10):1864–87.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Jones DL, Ross D, Weiss SM, Bhat G, Chitalu N. Influence of partner participation on sexual risk behavior reduction among HIV-positive Zambian women. J Urban Health. 2005;82(3):IV92–100.

    PubMed  Google Scholar 

  57. Koniak-Griffin D, Lesser J, Takayanagi S, Cumberland WG. Couple-focused human immunodeficiency virus prevention for young latino parents randomized clinical trial of efficacy and sustainability. Arch Pediatr Adolesc Med. 2011;165(4):306–12.

    Article  PubMed  Google Scholar 

  58. McGrath JW, Celentano DD, Chard SE, Fullem A, Kamya M, Gangakhedar RR, et al. A group-based intervention to increase condom use among HIV serodiscordant couples in India, Thailand, and Uganda. AIDS Care. 2007;19(3):418–24.

    Article  CAS  PubMed  Google Scholar 

  59. Carey MP, Carey KB, Maisto SA, Gordon CM, Weinhardt LS. Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients. Int J STD AIDS. 2001;12(6):365–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Burton J, Darbes LA, Operario D. Couples-focused behavioral interventions for prevention of HIV: systematic review of the state of evidence. AIDS Behav. 2010;14(1):1–10.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pequegnat W. AIDS behavioral prevention: unprecedented progress and emerging challenges. In: Mayer KH, Pizer HF, editors. The AIDS pandemic: impact on science and society. San Diego: Elsevier Academic Press; 2005. p. 236–60.

    Chapter  Google Scholar 

  62. Pequegnat W, Stover E. Payoff from AIDS behavioral prevention research. In: Mayer KH, Pizer HF, editors. HIV prevention: a comprehensive approach. London: Academic Press; 2009. p. 169–202.

    Google Scholar 

  63. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This trial was funded by the National Institute of Mental Health (NIMH) of the US National Institutes of Health through research grants to Dr. El-Bassel (U10 MH064395), Dr. Jemmott (U10 MH064394), Dr. Landis (U10 MH078819), Dr. Wingood (U10 MH064393), and Dr. Wyatt (U10 MH064404). Dr. Remien was supported by a grant from NIMH to the HIV Center for Clinical and Behavioral Studies (P30-MH45320). Dr. Pequegnat was the federal principal investigator (the NIMH staff collaborator). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health.

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Authors and Affiliations

  1. Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA

    Nabila El-Bassel

  2. Annenberg School for Communication and Department of Psychiatry, Perelman School of Medicine, Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, PA, 19104-3309, USA

    John B. Jemmott III

  3. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Scarlett L. Bellamy

  4. National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

    Willo Pequegnat

  5. Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Gina M. Wingood

  6. Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA

    Gail E. Wyatt

  7. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    J. Richard Landis

  8. Center for Clinical and Behavioral Studies, Department of Psychiatry, Columbia University, New York, NY, USA

    Robert H. Remien

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  1. Nabila El-Bassel
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  2. John B. Jemmott III
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The NIMH Multisite HIV/STD Prevention Trial for African American Couples Group

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Correspondence to John B. Jemmott III.

Additional information

A list of the members of the NIMH Multisite HIV/STD Prevention Trial for African American Couples Group was published in Journal of Acquired Immune Deficiency Syndromes, 2008; 49(suppl 1):S3-S14.

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El-Bassel, N., Jemmott, J.B., Bellamy, S.L. et al. Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples. AIDS Behav 20, 1197–1207 (2016). https://doi.org/10.1007/s10461-015-1249-x

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