Couples-based behavioral HIV prevention interventions have demonstrated efficacy, but few are routinely available in community-based settings in the United States. The Eban intervention, designed for heterosexual African American serodiscordant couples and proven efficacious in a cluster randomized trial, was implemented in community-based HIV service organizations in two cities disproportionately affected by the HIV epidemic. This article reports primarily on the effectiveness results related to condom use and results related to retention challenges within a Hybrid Type 2 implementation/effectiveness trial. Ninety-one individuals enrolled at baseline; 39 completed the posttest, and 30 completed the 3-month follow-up. Although condom use did not monotonically increase from baseline to posttest and 3-month follow-up, it did increase from baseline (44%) to posttest (73%), and from baseline to 3-month follow-up with an overall positive slope of Time 0.13 to 0.14 (p < .001). There was a significant increase in the number of people who used condoms 100% of the time from baseline (36.3%) to posttest (56.4%; p = .04) but not from baseline to 3-month follow-up (46.7%; p = .2907). Challenges with resources as basic as housing, food, and transportation complicated participation (and therefore implementation) and may have impeded couples' maintenance of risk reduction strategies beyond the intervention. In light of couples' numerous observed vulnerabilities, we constructed a composite score of "critical vulnerability" and found that depression was persistently related to critical vulnerability and that retention was higher among those with less vulnerability. These findings highlight the important yet underaddressed role of patient-level factors in the process and outcomes of hybrid implementation/effectiveness research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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针对 HIV 血清学不一致的非裔美国夫妇的循证干预的混合有效性/实施试验。

以夫妻为基础的行为 HIV 预防干预措施已证明有效，但在美国以社区为基础的环境中几乎没有常规可用。Eban 干预是为异性恋非裔美国人血清不一致夫妇设计的，并在集群随机试验中证明是有效的，在两个受 HIV 流行影响不成比例的城市的社区 HIV 服务组织中实施。本文主要报告与安全套使用相关的有效性结果以及与混合类型 2 实施/有效性试验中的保留挑战相关的结果。91 个人在基线登记；39 人完成了后测，30 人完成了 3 个月的随访。尽管安全套的使用从基线到后测和 3 个月的随访并没有单调增加，它确实从基线 (44%) 到后测 (73%)，以及从基线到 3 个月的随访，总体正斜率时间为 0.13 到 0.14 (p < .001)。从基线 (36.3%) 到后测 (56.4%；p = .04)，但从基线到 3 个月随访 (46.7%； p = .2907）。住房、食物和交通等基本资源的挑战使参与（并因此实施）变得复杂，并且可能阻碍了夫妻在干预之外维持降低风险的策略。针对夫妻观察到的众多漏洞，我们构建了“关键漏洞”的综合评分 并发现抑郁症持续与严重脆弱性相关，并且在脆弱性较低的人中保留率更高。这些发现强调了患者层面因素在混合实施/有效性研究的过程和结果中的重要作用，但尚未得到充分解决。（PsycInfo 数据库记录 (c) 2020 APA，保留所有权利）。