Optimizing a Community-Friendly HIV Risk Reduction Intervention for Injection Drug Users in Treatment: A Structural Equation Modeling Approach

Abstract

Research on behavioral HIV risk reduction interventions for injection drug users (IDUs) has focused on primary outcomes (e.g., reduced injection drug use, increased condom use) but has not fully examined the respective roles played by intervention components on these primary outcomes. In this paper, we present a structural equation modeling (SEM) approach in which we specify the causal pathways leading from theory-based intervention components to risk reduction outcomes among a sample of primarily IDUs (n = 226) participating in an inner-city community-based methadone maintenance program. Similar pathways were found leading to both drugand sexual-related risk reduction outcomes. Findings suggest the importance of targeting participants' risk reduction motivation and behavioral skills versus employing more passive informational strategies. Findings also indicate that our intervention may be optimized by focusing more on participants' risk reduction motivation within the sexual-related content and placing equivalent emphasis on participants' risk reduction knowledge, motivation, and behavioral skills within the drug-related content. By quantifying the specific linkage between intervention components and risk reduction outcomes, our SEM findings offer empirical guidance for optimizing this intervention. This strategy may also serve as a useful theory-and data-driven means to inform the refinement of other behavioral interventions.

Examining the Acceptability of mHealth Technology in HIV Prevention Among High-Risk Drug Users in Treatment

“…Individuals who met inclusion criteria, and who were willing to participate, were provided a description of the study and invited to provide informed consent, followed by the survey. Participants were assessed using audio computer assisted self-interview (ACASI) that has demonstrated sound psychometric properties in prior studies [42, 43] and controlled trials [44]. All participants were reimbursed for the time and effort needed to participate in the survey.…”

Modeling a theory-based approach to examine the influence of neurocognitive impairment on HIV risk reduction behaviors among drug users in treatment

“…Measures for the current study were adapted from previous HIV prevention work (50)(51)(52). Responses were analyzed as continuous measures, or dichotomized into an IMB strengths/deficits-based approaches.…”

“…Patients who met inclusion criteria, and who were willing to participate as subjects, were provided a description of the study and invited to provide informed consent, followed by a baseline assessment, which took approximately 120 minutes to complete. Participants were assessed using an ACASI process that has demonstrated sound psychometric properties in prior studies (51,55) and controlled trials (56), using an event-level sex-and drug-related HIV risk behavior assessment approach. All participants were reimbursed for the time and effort required to participate in the study.…”

Strategies for Primary HIV Prevention That Target Behavioral Change

“…The HHRP is now part of the Diffusion of Behavioral Interventions (DEBI) program posted on the CDC's Web site [24]. Recently, the HHRP was reduced to four 45-min sessions, and results are similar to those for the 12-session intervention [25].…”