Enhancing the health of women living with HIV: the SMART/EST Women's Project

Abstract

The principal objective of these multisite studies (Florida, New York, New Jersey: epicenters for human immunodeficiency virus [HIV] among women) was to develop and implement effective combinations of behavioral interventions to optimize the health status of the most neglected and understudied population affected by the acquired immunodeficiency syndrome (AIDS) epidemic in the United States: poor women of color living with HIV. The two studies enrolled nearly 900 women randomly assigned to “high intensity” (cognitive–behavioral stress management training combined with expressive–supportive therapy [CBSM]+ group) or “low intensity” (individual psychoeducational program) treatment conditions over a period of 9 years. The initial study of the stress management and relaxation training/expressive–supportive therapy (SMART/EST) Women’s Project (SWP I) focused on reducing depression and anxiety, as well as improving self-efficacy and overall quality of life for women with case-defined AIDS. Findings from this study demonstrated the utility of CBSM+ in reducing distress (depression, anxiety) and denial, while improving social support, self-efficacy, coping skills, and quality of life. The second study (SWP II), which included all women living with HIV, extended these findings by demonstrating that exposure to CBSM+ significantly improved the ability of the participants to take advantage of a health behavior change program encouraging the adoption and maintenance of healthier lifestyle behaviors (high levels of medication adherence, appropriate nutritional intake and physical activity, safer sexual practices, and reduced alcohol use/abuse) essential for optimal health in the context of living with HIV. SWP II also determined that the intervention program was equally beneficial to less-acculturated segments of the affected population (ie, non-English speaking HIV+ women) through the creation of culturally and linguistically sensitive Spanish and Creole versions of the program. A third study (SWP III) is currently underway to “translate” this evidence-based treatment program into Community Health Centers in Miami, New York City, and metropolitan New Jersey.

Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program

“…Assessments included health and risk behaviors drawn from the Behavioral Risk Factor Surveillance System (http://www.cdc.gov/brfss; including well-validated items for assessing physical activity and tobacco use), the adapted sexual risk behavioral assessment sched-ORIGINAL RESEARCH ule for adult [28] (sexual behavior and substance use prior to sex), and the COPE [29] (alcohol or drug use for emotional relief or problem solving) (for a detailed description of assessments, see Weiss et al [22]). In addition, the Stages of Change (SOC) [30] score was assessed for each health behavior.…”

“…The SWP has been described previously [22]. The program was developed within a cognitive behavioral stress management (CBSM) plus expressive supportive therapy [31] framework (CBSM+).…”

“…The translation demonstrated that the intervention could be translated to CHCs, conducted by CHC primary care staff, and sustained at four of the five participating CHCs, meeting the criteria for adoption, implementation, and maintenance [22]. The current study examines effectiveness, here being the impact of the intervention on multiple health behavior outcomes when comparing research staff-led (RES-Led) and CHC staff-led (CHC-Led) intervention groups.…”

“…The program was subsequently adapted to include all women living with HIV and translated linguistically and culturally from English into Spanish and Creole. A healthy lifestyle program targeting multiple health risk behaviors was incorporated, and the program was found to reduce stress/ distress and depression and anxiety, decrease HIV viral load, and enhance coping and self-efficacy, while improving health status and quality of life [15][16][17][18][19][20][21][22]. Between 2007 and 2011, a translation of this evidence-Implications Practice: The Stress Management and Relaxation Training/Expressive-Supportive Therapy Women's Program (SWP) can be implemented in community-based practice, utilizing existing community health center staff with diverse education levels and training backgrounds, and achieves improved health outcomes in women living with HIV.…”

Stress management interventions for HIV-infected individuals: review of recent intervention approaches and directions for future research

“…In addition to the computer-delivered intervention developed by Brown and colleagues for HIV-infected women, 100,101 two intervention trials evaluated the efficacy of a CBSM intervention tailored to the unique psychosocial stressors faced by HIV-infected women. 108,109 The first study examined the impact of a 10-week CBSM intervention on cervical intraepithelial neoplasia, the neoplastic changes that occur following sexual transmission of human papillomaviruses and are precursors to cervical cancer. 108 Women in the intervention condition endorsed decreased perceived life stress and had lower odds of cervical intraepithelial neoplasia over 9 months relative to the one psychoeducational control session.…”