title: Implementation of a couple-based HIV prevention program: a cluster randomized trial comparing manual versus Web-based approaches.
abstract: BACKGROUND
  Despite great need, the number of HIV prevention implementation studies remains limited. The challenge for researchers, in this time of limited HIV services agency resources, is to conceptualize and test how to disseminate efficacious, practical, and sustainable prevention programs more rapidly, and to understand how to do so in the absence of additional agency resources. We tested whether training and technical assistance (TA) in a couple-based HIV prevention program using a Web-based modality would yield greater program adoption of the program compared to training and TA in the same program in a manual-based modality among facilitators who delivered the interventions at 80 agencies in New York State.
  
  
  METHODS
  This study used a cluster randomized controlled design. Participants were HIV services agencies (N = 80) and up to 6 staff members at each agency (N = 253). Agencies were recruited, matched on key variables, and randomly assigned to two conditions. Staff members participated in a four-day, face-to-face training session, followed by TA calls at two and four months, and follow-up assessments at 6, 12, and 18 months post- training and TA. The primary outcomes examined number of couples with whom staff implemented the program, mean number of sessions implemented, whether staff implemented at least one session or whether staff implemented a complete intervention (all six sessions) of the program. Outcomes were measured at both the agency and participant level.
  
  
  RESULTS
  Over 18 months following training and TA, at least one participant from 13 (33%) Web-based assigned agencies and 19 (48%) traditional agencies reported program use. Longitudinal multilevel analysis found no differences between groups on any outcomes at the agency or participant level with one exception: Web-based agencies implemented the program with 35% fewer couples compared with staff at manual-based agencies (IRR 0.35, CI, 0.13-0.94).
  
  
  CONCLUSIONS
  Greater implementation of a Web-based program may require more resources and staff exposure, especially when paired with a couple-based modality. Manual-based and traditional programs may hold some advantage or ease for implementation, particularly at a time of low economic resources.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01863537.
authors.affiliation: Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Ave, New York 10027, NY, USA. ssw12@columbia.edu.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Witte
authors.forename: Elwin
authors.initials: E
authors.lastname: Wu
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.forename: Timothy
authors.initials: T
authors.lastname: Hunt
authors.forename: Louisa
authors.initials: L
authors.lastname: Gilbert
authors.forename: Katie Potocnik
authors.initials: KP
authors.lastname: Medina
authors.forename: Mingway
authors.initials: M
authors.lastname: Chang
authors.forename: Ryan
authors.initials: R
authors.lastname: Kelsey
authors.forename: Jessica
authors.initials: J
authors.lastname: Rowe
authors.forename: Robert
authors.initials: R
authors.lastname: Remien
mesh_terms: D000293:Adolescent; D000328:Adult; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D020407:Internet; D008297:Male; D009518:New York; D010353:Patient Education as Topic / Q000379:methods*; D016730:Program Development