title: Adapting an evidence-based HIV behavioral intervention for South African couples.
abstract: BACKGROUND
  In South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex.
  
  
  METHODS
  To address these interconnected HIV risks among heterosexual couples, we used the ADAPT framework to modify an existing, efficacious women's HIV prevention intervention (the Western Cape Women's Health CoOp) to include components of an evidence-based couple's intervention from the United States (Project Connect) and components from the Men as Partners program that has been used successfully in South Africa. We conducted focus groups with men, women and couples, and obtained feedback from a long-standing Community Collaborative Board (CCB) to guide the synthesis of elements of these three interventions into a new intervention. We then piloted the adapted intervention for feasibility and acceptability.
  
  
  RESULTS
  The new intervention is called the Couples' Health CoOp. This intervention targets men who use alcohol and other drugs and engage in unprotected sex, and their main female sex partners. The intervention addresses substance use, sex risk, HIV and other sexually transmitted infections, gender roles, gender-based violence, communication skills, and goal-setting activities to increase sexy (eroticize) safe-sex behaviors. The Couples' Health CoOp also includes "voices" from the focus group members to ground the intervention in the experiences of these at-risk couples. In addition, it utilizes a participant handbook that reiterates workshop content and includes homework assignments for couples to complete together to increase problem-solving skills within their relationship, and to improve their sexual relationship and help sustain HIV risk-reduction strategies. All of these adaptations were based on participants' suggestions made during formative work and pilot testing.
  
  
  CONCLUSIONS
  The Couples' Health CoOp is a couple-based HIV prevention intervention that targets alcohol and other drug use to reduce sexual risk, reduce gender-based violence and offer alternatives for conflict resolution, promote healthy relationships, and modify traditional gender roles in South Africa.
  
  
  BACKGROUND
  NCT01121692 .
authors.affiliation: Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC, USA. wmw@rti.org.|Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. wmw@rti.org.|Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA. wmw@rti.org.|Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA. wmw@rti.org.
authors.forename: Wendee M
authors.initials: WM
authors.lastname: Wechsberg
authors.affiliation: Columbia University School of Social Work, New York, NY, USA. ne5@columbia.edu.
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa. Tara.Carney@mrc.ac.za.
authors.forename: Tara
authors.initials: T
authors.lastname: Carney
authors.affiliation: Harvard School of Public Health, Boston, MA, USA. felicia.browne@mail.harvard.edu.
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Browne
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa. Bronwyn.Myers@mrc.ac.za.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. Bronwyn.Myers@mrc.ac.za.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Myers
authors.affiliation: Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC, USA. Zule@rti.org.
authors.forename: William A
authors.initials: WA
authors.lastname: Zule
mesh_terms: D019546:Couples Therapy / Q000379:methods*; D055317:Evidence-Based Practice / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D010865:Pilot Projects; D016730:Program Development; D040242:Risk Reduction Behavior; D013019:South Africa; D019966:Substance-Related Disorders / Q000523:psychology*; D047568:Unsafe Sex / Q000517:prevention & control*; D014754:Violence / Q000517:prevention & control