Effectiveness of healthy relationships video-group-A videoconferencing group intervention for women living with HIV: preliminary findings from a randomized controlled trial.

INTRODUCTION: 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. SUBJECTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Internet-based video-group delivery of Healthy Relationships--a "prevention with positives" intervention: report on a single group pilot test among women living with HIV.

Women living with HIV (WLH) face challenges related to stigma, disclosure of HIV status, and negotiating safer sex. Several effective behavioral interventions, such as Healthy Relationships (HR), help WLH address these challenges and are disseminated by the USA Centers for Disease Control and Prevention's (CDC) Diffusion of Effective Behavioral Interventions project. However, many WLH living in poor urban or rural locations cannot access interventions such as HR because implementation is not feasible. Video-conferencing technology holds promise for expanding access to effective behavioral interventions for WLH. Following a systematic adaptation to the video-conferencing format, this pilot study tested the delivery of HR via video-group (VG) among WLH. The video-conferencing-based intervention, HR-VG, consisted of six, two-hour sessions led by two facilitators, and used structured activities and video-clips to build disclosure and safer sex skills. Four minority WLH received HR-VG at four different community-based intervention sites in a private room equipped with a video-phone for participating in HR-VG and a desktop computer for completing assessments via Audio Computer-Assisted Self Interview. Participants completed a baseline assessment prior to HR-VG and post-session assessment after each HR-VG session. The post-intervention assessment and video-focus group were completed following the last HR-VG session. Facilitators completed an assessment after each HR-VG session and an open-ended questionnaire following HR-VG. HR-VG was implemented in its entirety with minimal challenges. Both participants and facilitators reported feeling either "very comfortable" or "completely comfortable" with the technology and the overall intervention. Participants also reported high levels of unity and togetherness among the group. These preliminary findings suggest VG delivery of HR for WLH is both feasible and highly valued by participants. A follow-up randomized controlled trial is under way to test the feasibility and efficacy of HR-VG with a larger sample of WLH.