title: Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples.
abstract: Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.
authors.affiliation: Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA.
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.affiliation: Annenberg School for Communication and Department of Psychiatry, Perelman School of Medicine, Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, PA, 19104-3309, USA. jjemmott@asc.upenn.edu.
authors.forename: John B
authors.initials: JB
authors.lastname: Jemmott
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Willo
authors.initials: W
authors.lastname: Pequegnat
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Wingood
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Wyatt
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J Richard
authors.initials: JR
authors.lastname: Landis
authors.affiliation: Center for Clinical and Behavioral Studies, Department of Psychiatry, Columbia University, New York, NY, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Remien
mesh_terms: D001741:Black or African American; D017280:Condoms / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006293:Health Promotion; D006801:Humans; D008297:Male; D017008:Negotiating; D040242:Risk Reduction Behavior; D021841:Safe Sex; D020377:Self Efficacy; D012747:Sexual Partners; D047568:Unsafe Sex
keywords: Condom use; HIV serodiscordant couples; Intervention; Mediation analysis; Social Cognitive Theory