Effects of a Couple-Based Intervention to Reduce Risks for HIV, HCV, and STIs Among Drug-Involved Heterosexual Couples in Kazakhstan

Abstract

Objective Project Renaissance is a randomized controlled trial of an HIV/HCV/STI prevention intervention conducted in Almaty, Kazakhstan. We hypothesized that couples assigned to the intervention of interest will have lower incidence of HIV, HCV, sexually transmitted infections (STI), rates of unprotected sex, and unsafe injection over the 12-month follow up period compared to those assigned to an attention control arm. Design A total of 300 couples (600 participants) where one or both partners reported injecting drugs in the past 90 days were randomized to one of two arms: (1) a five-session HIV/HCV/STI prevention intervention (Risk Reduction: RR), or (2) a five-session Wellness Promotion (WP) intervention. Results Over the 12-month follow up period, assignment to RR compared to WP significantly lowered the incidence of HCV infection by 69% (IRR=0.31, 95% CI=0.10 – 0.90, p=0.031). Although differences were not statistically significant, RR participants had a lower incidence of HIV infection by 51% (IRR=0.49, 95% CI=0.16 – 1.48, p=0.204) and any STI by 37% (IRR=0.63, 95%=0.21 – 1.93, p=0.418) than WP participants. RR participants reported significantly fewer numbers of unprotected vaginal sex acts with their study partners (IRR=0.58, 95% CI=0.36 – 0.93, p=0.024) and more consistent condom use (OR=2.30, 95% CI=1.33 – 4.00, p=0.003) over the entire follow-up period compared to WP participants. Conclusion Project Renaissance demonstrated a significant effect for biological and behavioral endpoints. Findings draw attention to an HIV/HCV/STI prevention intervention strategy that can be scaled up for drug-involved couples in harm reduction programs, drug treatment, and criminal justice settings.

The male factor: Outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township

“…The CHC extends the WHC by integrating essential components from Project Connect (El-Bassel et al, 2003; Wechsberg et al, 2015), an efficacious couples-based HIV intervention that has been used in other settings and populations (El-Bassel et al, 2014; 2011; 2010) and was adapted and pilot tested as descibed by Wechsberg et al (2015). The CHC reinforced positive dimensions of couples’ relationships with skill-building exercises, particularly around communication and sexual expectations, and the use of a handbook that bolstered sessions with a commitment pledge and take-home activities that couples were asked to complete together.…”

Intimate relationships and patterns of drug and sexual risk behaviors among people who inject drugs in Kazakhstan: A latent class analysis

“…Individual factors include drug and alcohol use severity, which increases injection drug and sexual risk behaviors in Central Asia and other parts of the world (Azbel et al, 2015; El-Bassel et al, 2013a; 2013b; El-Bassel et al, 2014a; 2014b; 2014c; Marotta and El-Bassel, 2017). The rate of alcohol consumption in Kazakhstan is the highest in Central Asia with rates of alcohol use disorders of about 8% (WHO, 2015).…”

Social and Structural Challenges to Drug Cessation Among Couples in Northern Mexico: Implications for Drug Treatment in Underserved Communities

“…Although the development of such programs will require dedicated resources, several couples in this study explicitly expressed interest in relocating to “healthier” environments. Finally, new and existing programs should offer integrated mental health and social services (El-Bassel et al, 2014; Jiwatram-Negrón & El-Bassel, 2014; Klostermann, Kelley, Mignone, Pusateri, & Wills, 2011; Schumm, O'Farrell, & Andreas, 2012). …”