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Predictors and moderators of outcomes of HIV/STD sex risk reduction interventions in substance abuse treatment programs: a pooled analysis of two randomized controlled trials

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      Abstract

      Background

      The objective of the current study was to examine predictors and moderators of response to two HIV sexual risk interventions of different content and duration for individuals in substance abuse treatment programs.

      Methods

      Participants were recruited from community drug treatment programs participating in the National Institute on Drug Abuse Clinical Trials Network (CTN). Data were pooled from two parallel randomized controlled CTN studies (one with men and one with women) each examining the impact of a multi-session motivational and skills training program, in comparison to a single-session HIV education intervention, on the degree of reduction in unprotected sex from baseline to 3- and 6- month follow-ups. The findings were analyzed using a zero-inflated negative binomial (ZINB) model.

      Results

      Severity of drug use ( p < .01), gender ( p < .001), and age ( p < .001) were significant main effect predictors of number of unprotected sexual occasions (USOs) at follow-up in the non-zero portion of the ZINB model (men, younger participants, and those with greater severity of drug/alcohol abuse have more USOs). Monogamous relationship status ( p < .001) and race/ethnicity ( p < .001) were significant predictors of having at least one USO vs. none (monogamous individuals and African Americans were more likely to have at least one USO). Significant moderators of intervention effectiveness included recent sex under the influence of drugs/alcohol ( p < .01 in non-zero portion of model), duration of abuse of primary drug ( p < .05 in non-zero portion of model), and Hispanic ethnicity ( p < .01 in the zero portion, p < .05 in the non-zero portion of model).

      Conclusion

      These predictor and moderator findings point to ways in which patients may be selected for the different HIV sexual risk reduction interventions and suggest potential avenues for further development of the interventions for increasing their effectiveness within certain subgroups.

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      Most cited references 41

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      Likelihood Ratio Tests for Model Selection and Non-Nested Hypotheses

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        Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control

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          Substance abuse treatment entry, retention, and outcome in women: a review of the literature.

          This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.
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            Author and article information

            Affiliations
            [1 ]Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
            [2 ]Department of Mathematics, West Chester University, West Chester, PA, USA
            [3 ]Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
            [4 ]The Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, USA
            Contributors
            Journal
            Subst Abuse Treat Prev Policy
            Subst Abuse Treat Prev Policy
            Substance Abuse Treatment, Prevention, and Policy
            BioMed Central
            1747-597X
            2014
            16 January 2014
            : 9
            : 3
            24433412
            3929547
            1747-597X-9-3
            10.1186/1747-597X-9-3
            Copyright © 2014 Crits-Christoph et al.; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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