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Onaisi R, Joseph JP, Castera P, Pontgratz C. Sexual risk behaviour reduction interventions in primary care in Organization of Economic Cooperation and Development countries. A systematic review. Fam Pract 2022; 39:762-770. [PMID: 34668006 DOI: 10.1093/fampra/cmab131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Sexually transmitted infections are a major public health issue, both in France and worldwide. Primary healthcare professionals play a key role in sexual health and prevention, but few take on this subject. Prevention strategies are diverse, thus risk reduction strategies focussing on behavioural changes are still needed. PURPOSE We conducted a systematic review to analyse risk reduction interventions focussing on behavioural change in OECD countries in primary healthcare settings to help develop a prevention tool easy to apply in primary care. METHODS We searched for English- or French-language controlled trials in PubMed, Cochrane Library, Scopus, PsycINFO, PsycArticle, PBSC, SocINDEX, Google Scholar, and CAIRN, supplemented with the bibliographies of previous systematic reviews. Thirty controlled, randomized, or nonrandomized trials were included in the systematic review. We did not conduct any meta-analysis due to the diversity of populations, outcomes and study designs. RESULTS There are efficient interventions in primary healthcare settings for reducing sexual risk behaviours and/or incident STI. Their efficiency seems to grow with the length and intensity of the intervention. Most interventions target only young, high-risk patients, and their long-term impact is uncertain. Most included studies had an overall risk of bias estimated as high or with some concerns. CONCLUSIONS Some tools could be used in primary care, with possible efficiency though results are difficult to generalize, and value should be assessed in daily practice. Future research should also focus on older population given the epidemiological evolutions, but also lower-risk population to target all patients seen in primary care settings.
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Affiliation(s)
- Racha Onaisi
- Department of General Practice, University of Bordeaux, Bordeaux, France
| | - Jean-Philippe Joseph
- Department of General Practice, University of Bordeaux, Bordeaux, France.,CIC 1401-EC (Clinical Epidemiology), Bordeaux, France.,Inserm U1219, Univ. Bordeaux, Bordeaux, France
| | - Philippe Castera
- Department of General Practice, University of Bordeaux, Bordeaux, France
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Spence AB, Wang C, Michel K, Ocampo JM, Kharfen M, Merenstein D, Goparaju L, Kassaye S. HIV Related Stigma among Healthcare Providers: Opportunities for Education and Training. J Int Assoc Provid AIDS Care 2022; 21:23259582221114797. [PMID: 35850610 PMCID: PMC9310064 DOI: 10.1177/23259582221114797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: HIV-stigma can influence engagement in care and viral suppression rates among persons living with HIV (PLWH). Understanding HIV-provider level stigma and its associated factors may aid in development of interventions to improve engagement in care. Methods: We assessed HIV-related stigma, provider knowledge, and practices and beliefs among healthcare providers using an online survey tool. Generalized linear modeling was used to determine factors associated with HIV-stigma score. Results: Among 436 participants, the mean age was 42.3 (SD 12.3), 70% female, 62% white, 65% physicians, and 44% worked at an academic center. The mean HIV Health Care Provider Stigma Scale (HPASS) score was 150.5 (SD 18.9, total = 180 [higher score = less stigma]) with factor subscale scores of 67.1 (SD 8.2, total = 78) prejudice, 51.3 (SD 9.7, total = 66) stereotyping, and 32.1 (SD 5, total = 36) discrimination. Female sex and comfort with talking about sex and drug use had 4.97 (95% CI 0.61, 9.32) and 1.99 (95% CI 0.88, 3.10) estimated higher HPASS scores. Disagreement/strong disagreement versus strong agreement with the statement that PLWH should be allowed to have babies and feeling responsible for talking about HIV prevention associated with -17.05 (95% CI -25.96, -8.15) and -2.16 (95% CI -3.43, -0.88) estimated lower HPASS scores. Conclusions: The modifiable factors we identified as associated with higher HIV related stigma may provide opportunities for education that may ameliorate these negative associations.
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Affiliation(s)
- Amanda Blair Spence
- Division of Infectious Disease, Georgetown University Medical
Center, Washington, DC, USA,Amanda Blair Spence, Division of Infectious
Disease, Georgetown University Medical Center, 3800 Reservoir Road, NW 5th Floor
PHC, Washington, DC 20007, USA.
| | - Cuiwei Wang
- Division of Infectious Disease, Georgetown University Medical
Center, Washington, DC, USA
| | - Katherine Michel
- Division of Infectious Disease, Georgetown University Medical
Center, Washington, DC, USA
| | - Joanne Michelle Ocampo
- Department of Population and Family Health, Mailman School of Public Health, Columbia
University, New York, NY, USA
| | - Michael Kharfen
- District of Columbia Department of
Health, HIV/AIDS, Hepatitis, STD & TB Administration, Washington,
DC, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical
Center, Washington, DC, USA
| | - Lakshmi Goparaju
- Division of Infectious Disease, Georgetown University Medical
Center, Washington, DC, USA
| | - Seble Kassaye
- Division of Infectious Disease, Georgetown University Medical
Center, Washington, DC, USA
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3
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Hatch MA, Wells EA, Masters T, Beadnell B, Harwick R, Wright L, Peavy M, Ricardo-Bulis E, Wiest K, Shriver C, Baer JS. A randomized clinical trial evaluating the impact of counselor training and patient feedback on substance use disorder patients' sexual risk behavior. J Subst Abuse Treat 2022; 140:108826. [PMID: 35751944 DOI: 10.1016/j.jsat.2022.108826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/22/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION High risk sex-such as sex with multiple partners, condomless sex, or transactional or commercial sex-is a risk factor in individuals with substance use disorders (SUDs). SUD treatment can reduce sexual risk behavior, but interventions to reduce such behavior in this context have not been consistently effective. This study sought to determine if the impact of treatment on sexual risk behavior can be increased. METHODS In a nested 2 × 2 factorial repeated measures design, we examined outcomes of two interventions: training for counselors in talking to patients about sexual risk; and availability to both counselors and patients of a personalized feedback report based on patient self-report of sexual behavior. Counselors received either a brief, information-based, Basic Training, or a multi-session, skills-based Enhanced Training. Their patients completed an audio-assisted computerized assessment of sexual behavior and received either No Feedback or a Personalized Feedback Report (PFR). Four hundred seventy six patients participated. Patient follow-up occurred 3- and 6-months postbaseline. Primary patient outcome measures were Number of Unsafe Sex Occasions (USO) and whether patients reported talking about sex in counseling sessions (Discussed Sex), both in the past 90 days. Secondary outcomes included Number of Sexual Partners, Sex Under the Influence of Substances, and Perceived Condom Barriers. RESULTS Patients of Enhanced-condition counselors compared to those of Basic-condition counselors were more likely to report talking about sex with their counselor at 6-month follow-up. Personalized feedback also increased the likelihood of reporting counselor discussions at 6-month follow-up. Neither the training nor the feedback condition affected USO, Number of Partners, or Sex Under the Influence. DISCUSSION We discuss why these two interventions apparently altered counselor-patient communication about sexual risk behavior without affecting the behavior itself.
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Affiliation(s)
- Mary A Hatch
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States; University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, 1959 NE Pacific St., Seattle, WA 98195, United States.
| | - Elizabeth A Wells
- Emeritus, University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, United States
| | - Tatiana Masters
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States
| | - Blair Beadnell
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States
| | - Robin Harwick
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States
| | - Lynette Wright
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States
| | - Michelle Peavy
- Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA 98134, United States
| | - Esther Ricardo-Bulis
- Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA 98134, United States
| | - Katerina Wiest
- CODA, Inc., 1027 E. Burnside St., Portland, OR 97214, United States
| | - Carrie Shriver
- Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA 98134, United States
| | - John S Baer
- University of Washington Department of Psychology, Guthrie Hall, Seattle, WA 98195-1525, United States
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Carey JW, Carnes N, Schoua-Glusberg A, Kenward K, Gelaude D, Denson DJ, Gall E, Randall LA, Frew PM. Barriers and Facilitators for Antiretroviral Treatment Adherence Among HIV-Positive African American and Latino Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:306-324. [PMID: 31361514 PMCID: PMC10985706 DOI: 10.1521/aeap.2019.31.4.306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Some Black/African American and Hispanic/Latino men who have sex with men (MSM) living with HIV do not take antiretroviral therapy (ART). We conducted semistructured interviews with 84 adult, Black/African American and Hispanic/Latino MSM with HIV to understand ART barriers and facilitators. We used chi-square statistics to identify factors associated with ART use (p ≤ .05), and selected illustrative quotes. Over half (51.2%) said they followed their doctor's instructions; however, only 27.4% reported consistently taking ART. Some men delayed ART until overcoming diagnosis denial or becoming very sick. ART use was facilitated by encouragement from others, treatment plans, side effect management, lab test improvements, pill-taking reminders, and convenient care facilities that provide "one-stop shop" services. Men were more likely to take ART when having providers who communicated effectively and were perceived to treat them with respect. Healthcare personnel can use our findings to strengthen services for MSM of color.
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Affiliation(s)
- James W Carey
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Neal Carnes
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | | | - Deborah Gelaude
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Damian J Denson
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | - Laura A Randall
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, and the University of Nevada School of Public Health and UNLV Health for Nevada: Health Disparities Initiative, Las Vegas, Nevada
| | - Paula M Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, and the University of Nevada School of Public Health and UNLV Health for Nevada: Health Disparities Initiative, Las Vegas, Nevada
- Emory Rollins School of Public Health, Hubert Department of Global Health and the Department of Behavioral Sciences and Health Education, Atlanta, Georgia
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5
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Hatch-Maillette MA, Harwick R, Baer JS, Wells EA, Masters T, Robinson A, Cloud K, Peavy M, Wiest K, Wright L, Dillon K, Beadnell B. Increasing substance use disorder counselors' self-efficacy and skills in talking to patients about sex and HIV risk: A randomized training trial. Drug Alcohol Depend 2019; 199:76-84. [PMID: 31026713 PMCID: PMC6759210 DOI: 10.1016/j.drugalcdep.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND People with substance use disorder (SUD) experience increased risk for HIV, Hepatitis C, and sexually transmitted illnesses via risky sex. This high-risk population would benefit from sexual risk reduction interventions integrated into SUD treatment. However, many SUD counselors report lack of skill or confidence in addressing sexual risk with patients. METHODS This study was part of a larger nested 2 × 2 factorial repeated measures design, which compared two levels of counselor training (Basic-2 h versus Enhanced-10 h plus ongoing coaching). We determined whether counselors receiving Enhanced training addressing their motivation, confidence and skills (a) increased knowledge about sexual issues; (b) increased self-efficacy to discuss sex with patients; and (c) improved skills in discussing sex as part of SUD treatment, compared with those receiving shorter information-based training. Counselors providing individual therapy at two opioid treatment programs (OTP) and two psychosocial outpatient programs in the United States were eligible. Randomization occurred after Basic training. Measures included self-report (self-efficacy and knowledge) and blinded coding of standardized patient interviews (skill). RESULTS Counselors receiving Enhanced training (n = 28) showed significant improvements compared to their Basic training counterparts (n = 32) in self-efficacy, use of reflections, and use of decision-making and communication strategies with standardized patients. These improvements were maintained from post-training to 3-month follow-up. No adverse effects of study participation were reported. CONCLUSIONS Results suggest that counselors can improve their knowledge, self-efficacy and skill related to sexual risk conversations with patients based on modest skills-based training.
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Affiliation(s)
- Mary A Hatch-Maillette
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98105, USA.
| | - Robin Harwick
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA
| | - John S Baer
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA; VA Puget Sound Healthcare System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Elizabeth A Wells
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA; Emeritus, University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA, 98105, USA
| | - Tatiana Masters
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA
| | - Audra Robinson
- Department of Psychology, University of Washington, 119A Guthrie Hall Box 351525, Seattle, WA, 98195, USA
| | - Kasie Cloud
- CODA, Inc., 1027 E. Burnside St., Portland, OR, 97214, USA
| | - Michelle Peavy
- Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA, 98134, USA
| | | | - Lynette Wright
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA
| | | | - Blair Beadnell
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA
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Chorba T, Scholes D, Bluespruce J, Operskalski BH, Irwin K. Sexually Transmitted Diseases and Managed Care: An Inquiry and Review of Issues Affecting Service Delivery. Am J Med Qual 2016; 19:145-56. [PMID: 15368779 DOI: 10.1177/106286060401900403] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To understand the potential role of managed care organizations (MCOs) in prevention and control of sexually transmitted diseases (STDs), we conducted a systematic review of articles on STDs and managed care and sought qualitative information from MCOs on STD-related activities. The review focused on prevention, risk assessment, patient education, counseling, screening, and costs of care, but revealed relatively few published articles. Barriers to STD service delivery included competing priorities, lack of time or supporting organizational structures, and differing mandates of health departments and MCOs. Facilitators included collaboration between health departments and MCOs, regulatory and performance incentives, buy-in from key stakeholders, availability of infrastructure to support data collection, and inclusion of chlamydia screening in the Health Employer Data and Information Set to monitor plan performance. Because of the shift of STD service delivery from the public to private sector, incentives need to maximize interest and cooperation of patients, clinicians, and MCOs in STD prevention.
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Affiliation(s)
- Terence Chorba
- Health Services and Evaluation Branch, Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Bradley-Springer LA, Everett MR, Rotach EG, Vojir CP. Changes in Clinician Ability to Assess Risk and Help Patients Determine the Need for Hiv Testing. Eval Health Prof 2016; 29:367-93. [PMID: 17102061 DOI: 10.1177/0163278706293404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An estimated one of four people with HIV in the United States do not know they have the infection. The Centers for Disease Control and Prevention encourages HIV testing in clinical settings, but there is evidence that this is not done on a regular basis. The purposes of this study were to (a) compare two less traditional teaching methods with a classroom method to determine whether the less traditional methods resulted in greater improvement of clinician knowledge, skill, and willingness to perform HIV risk assessment as the basis for recommending HIV testing; and (b) find out whether there were significant differences in convenience, cost, learner preference, or learner acceptance that would make one method more desirable than the others. Findings from participants in the standardized patient interaction with facilitator feedback (FB) and the case-based self-study module (SSM) were not different from those of participants in the interactive classroom education method (CL). Generally, there were positive changes in knowledge, attitudes, and behaviors over time. Participants preferred standardized patient interaction (FB) and interactive classes (CL) to self-study modules (SSM).
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Levy ME, Wilton L, Phillips G, Glick SN, Kuo I, Brewer RA, Elliott A, Watson C, Magnus M. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav 2014; 18:972-96. [PMID: 24531769 PMCID: PMC4509742 DOI: 10.1007/s10461-014-0719-x] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.
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Affiliation(s)
- Matthew E Levy
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA,
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9
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Dorell CG, Sutton MY, Oster AM, Hardnett F, Thomas PE, Gaul ZJ, Mena LA, Heffelfinger JD. Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic. AIDS Patient Care STDS 2011; 25:657-64. [PMID: 21923415 DOI: 10.1089/apc.2011.0203] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Limited health care access and missed opportunities for HIV and other sexually transmitted infection (STI) education and testing in health care settings may contribute to risk of HIV infection. In 2008, we conducted a case-control study of African American men who have sex with men (MSM) in a southeastern city (Jackson, Mississippi) with an increase in numbers of newly reported HIV cases. Our aims were to evaluate associations between health care and HIV infection and to identify missed opportunities for HIV/STI testing. We queried 40 potential HIV-infected cases and 936 potential HIV-uninfected controls for participation in this study. Study enrollees included HIV-infected cases (n=30) and HIV-uninfected controls (n=95) who consented to participate and responded to a self-administered computerized survey about sexual risk behaviors and health care utilization. We used bivariate analysis and logistic regression to test for associations between potential risk factors and HIV infection. Cases were more likely than controls to lack health insurance (odds ratio [OR]=2.5; 95% confidence interval [CI]=1.1-5.7), lack a primary care provider (OR=6.3; CI=2.3-16.8), and to not have received advice about HIV or STI testing or prevention (OR=5.4; CI=1.3-21.5) or disclose their sexual identity (OR=7.0; CI=1.6-29.2) to a health care provider. In multivariate analysis, lacking a primary health care provider (adjusted odds ratio [AOR]=4.5; CI=1.4-14.7) and not disclosing sexual identity to a health care provider (AOR=8.6; CI=1.8-40.0) were independent risk factors for HIV infection among African American MSM. HIV prevention interventions for African American MSM should address access to primary health care providers for HIV/STI prevention and testing services and the need for increased discussions about sexual health, sexual identity, and sexual behaviors between providers and patients in an effort to reduce HIV incidence and HIV-related health disparities.
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Affiliation(s)
- Christina G. Dorell
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline Y. Sutton
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexandra M. Oster
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Felicia Hardnett
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter E. Thomas
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zaneta J. Gaul
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leandro A. Mena
- University of Mississippi Medical Center and Mississippi State Department of Health, Jackson, Mississippi
| | - James D. Heffelfinger
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ferrer LM, Cianelli R, Norr KF, Cabieses B, Araya A, Irarrázabal L, Bernales M. Observed use of standard precautions in Chilean community clinics. Public Health Nurs 2009; 26:440-8. [PMID: 19706127 DOI: 10.1111/j.1525-1446.2009.00802.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In Chile, little information about the use of standard precautions (SP) among health care workers (HCWs) exists. As part of a larger study to tailor and test an HIV prevention intervention for community HCWs, this study describes the observed frequency with which appropriate SP were used by HCWs in low-income community clinics of Santiago. Also, the availability of supplies is described. SAMPLE A total of 52 structured observations with potential contamination with body fluids were done. RESULTS HCWs used SP inconsistently, especially neglecting hand washing, surface cleaning, and cleaning of shared materials. Lack of materials contributed in some instances of failure to use SPs, especially wiping surfaces and safe disposal of sharp instruments, as shown by a positive correlation between use of SP and availability of materials. Essential materials were usually available. Although more education should relate to a better understanding of the importance of SP, no difference was found between professionals and paraprofessionals in the use of SP. CONCLUSIONS It is clear that the initial training, continuing education, and ongoing support for practicing SP are not adequate. Training should be offered to HCWs involved in caring for clients at community clinics to stop the spread of HIV or other infectious diseases in health care settings.
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Affiliation(s)
- Lilian Marcela Ferrer
- Associate Professor, School of Nursing, Pontificia Universidad Católica de Chile, Vicuña Mackena 4860, Macul, Santiago 6904411, Chile.
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11
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Drainoni ML, Dekker D, Lee-Hood E, Boehmer U, Relf M. HIV medical care provider practices for reducing high-risk sexual behavior: results of a qualitative study. AIDS Patient Care STDS 2009; 23:347-56. [PMID: 19413497 DOI: 10.1089/apc.2008.0063] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A first step in ensuring that HIV-infected persons practice the safer sexual behaviors that reduce disease transmission is to make certain that they receive accurate information about the relationship between sexual risk behaviors and HIV transmission. Health care providers can play a pivotal role in preventing secondary transmission of HIV; federal agencies and professional guidelines encourage providers to counsel HIV-infected patients about safer sex practices and transmission risks, particularly since the health care encounter may be the only time that HIV-infected persons receive information about prevention and risk reduction interventions. Yet research indicates that these opportunities are often missed. Prior to implementing a prevention demonstration project in an urban HIV and STD clinic, we conducted a qualitative investigation with providers, including physicians, nurse practitioners, physician assistants, and nurses. The purpose of this investigation was to examine the current status of prevention education and counseling efforts at the clinic, examine the barriers and facilitators to providing prevention counseling, and identify key areas where providers believed that they needed additional training.
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Affiliation(s)
- Mari-Lynn Drainoni
- Boston University School of Public Health, Boston, Massachusetts
- Center for Health Quality, Outcomes, and Economic Research, E.N.R. Veterans Administration Hospital, Bedford, Massachusetts
| | | | - Elizabeth Lee-Hood
- Boston University School of Public Health, Boston, Massachusetts
- Center for Health Quality, Outcomes, and Economic Research, E.N.R. Veterans Administration Hospital, Bedford, Massachusetts
| | - Ulrike Boehmer
- Boston University School of Public Health, Boston, Massachusetts
| | - Michael Relf
- School of Nursing, Duke University, Durham, North Carolina
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12
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STD/HIV prevention practices among primary care clinicians: risk assessment, prevention counseling, and testing. Sex Transm Dis 2008; 35:154-66. [PMID: 18007273 DOI: 10.1097/olq.0b013e3181574d97] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe current practices of primary care (PC) clinicians for STD/HIV control services: risk assessment, prevention counseling, and offering tests. STUDY DESIGN We identified clinical strategies through qualitative interviews. We then surveyed by mail a random sample of Washington State family physicians, general internists, obstetrician-gynecologists, nurse practitioners, and certified nurse midwives. We identified characteristics of clinicians and their practices associated with each strategy and universal provision of each service. RESULTS We report on 519 clinicians (80% adjusted response rate). Clinicians provided services to selected patients they considered high risk. Universal practices were less common: risk assessment (56%), prevention counseling (60%), STD tests (30%), and HIV tests (19%). Universal services were more common among nurses, those recently trained, and those seeing more STD patients. CONCLUSION Different types of PC clinicians use widely differing clinical strategies and many use selective rather than universal approaches to STD/HIV control services. Further research is needed to develop tailored interventions to improve provision of these services.
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Nollen C, Drainoni ML, Sharp V. Designing and delivering a prevention project within an HIV treatment setting: lessons learned from a specialist model. AIDS Behav 2007; 11:S84-94. [PMID: 17577654 DOI: 10.1007/s10461-007-9254-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 05/15/2007] [Indexed: 10/23/2022]
Abstract
This paper presents lessons learned from an intervention designed to provide HIV prevention counseling within a hospital-based, multidisciplinary HIV clinic. The model, Positive Prevention, used Master's-level social workers (MSWs) as intervention specialists to minimize burden on primary care providers and to offer a replicable way to provide prevention in a similar setting. The intervention goal was to reduce risk behaviors through Motivational Interviewing, a patient-centered counseling approach with proven success impacting behavioral change. Implementation experiences offer insight into the challenges of using MSWs as prevention specialists. Particular challenges were related to patient engagement and retention. Experiences early in the implementation process were informative and allowed for adaptations to facilitate a more viable program; however even after executing new strategies, many of the program issues remained. Thus, the Positive Prevention model is not recommended as a best HIV prevention model for replication in similar high-volume, hospital-based, multidisciplinary HIV clinic settings.
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Affiliation(s)
- Christine Nollen
- Center for Comprehensive Care, St. Luke's Roosevelt Hospital Center, 1111 Amsterdam Avenue, Stuyvesant 7, New York, NY 10025, USA.
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Wilkinson JD, Zhao W, Santibanez S, Arnsten J, Knowlton A, Gómez CA, Metsch LR. Providers' HIV prevention discussions with HIV-seropositive injection drug users. AIDS Behav 2006; 10:699-705. [PMID: 16639542 DOI: 10.1007/s10461-006-9088-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Public health agencies have recommended incorporating HIV prevention counseling into the medical care of persons living with HIV/AIDS. Injection drug users (IDUs) especially need HIV risk-reduction counseling because of their high risk for HIV transmission through both sexual and injection behaviors. The objective of this study was to assess the prevalence of, and patient factors associated with, the delivery of HIV prevention messages to HIV-seropositive IDUs in primary care settings. A majority of participants reported having an HIV prevention discussion with their provider during their most recent primary care visit. Factors significantly associated with report of such discussion were being Hispanic or non-Hispanic Black; high school education or less; and better perception of engagement with provider. Medical providers should provide prevention messages to all HIV-seropositive IDUs, regardless of demographic factors. Effective HIV prevention interventions in primary care settings, including interventions to improve patient-provider communication, are needed for HIV-seropositive IDUs.
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Affiliation(s)
- James D Wilkinson
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, 1801 NW 9th Avenue, Suite 200, FL 33136, USA.
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15
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Wolitski RJ, Jones KT, Wasserman JL, Smith JC. Self-identification as "down low" among men who have sex with men (MSM) from 12 US cities. AIDS Behav 2006; 10:519-29. [PMID: 16691462 DOI: 10.1007/s10461-006-9095-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Men who have sex with men (MSM) who are on the "down low" (DL) have been the subject of considerable media attention, but few data on this population exist. This exploratory study (N=455) compared MSM who considered themselves to be on the DL with MSM who did not (non-DL MSM). 20% self-identified as DL. Blacks and Hispanics were more likely than Whites to self identify as DL. MSM who did not identify as gay were more likely than gay-identified MSM to describe themselves as DL. DL-identified MSM were less likely to have had seven or more male partners in the prior 30 days, but were more likely to have had a female sex partner and to have had unprotected vaginal sex. DL-identified MSM were less likely to have ever been tested for HIV than were non-DL MSM. Prevention agencies should expand existing programs for MSM to include specific efforts to reach DL MSM.
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Affiliation(s)
- Richard J Wolitski
- Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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16
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Boekeloo BO, Griffin MA. Review of Clinical Trials Testing the Effectiveness of Clinician Intervention Approaches to Prevent Sexually Transmitted Diseases in Adolescent Outpatients. Curr Pediatr Rev 2005; 1:173-185. [PMID: 25657616 PMCID: PMC4315618 DOI: 10.2174/1573396054065457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Identify approaches for improving clinician provision of sexually transmitted diseases (STDs) prevention services among outpatient adolescents. METHODS Reviewed all peer-reviewed, published clinical trials identified through computerized searches (MEDLINE, PsychINFO) evaluating STD prevention services to outpatient adolescents by clinicians. RESULTS Five trials were identified examining changes in clinician provision of STD prevention services. Two of these trials resulted in adolescent self-reported risk reduction but neither of these trials effectively demonstrated reductions in objectively measured STD incidence. Nine clinical trials were identified that compared clinician with non-clinician provision of STD prevention services. Four of these trials resulted in adolescent self-reported risk reduction, and one of these trials demonstrated a reduction in objectively measured STD incidence. CONCLUSIONS Trials indicate that improvement in outpatient adolescent STD incidence is possible with non-clinicians as interventionists, and perhaps clinicians as interventionists if clinicians are supported by other educational resources. Opportunities for personalized, interactive adolescent education appears key to intervention success. The clinician role that is tested in most trials is confined to a single brief encounter with little attention to: development of clinician skills, quality of psychosexual risk assessment and tailoring to meet individual adolescent need, systems-level resources and supports, the parental role, or the impact of incorporating prevention into an ongoing adolescent-clinician relationship.
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Affiliation(s)
- Bradley O Boekeloo
- University of Maryland, Department of Public and Community Health, College Park, Maryland 20742, 301-405-8546, FAX: 301-314-6598
| | - Melinda A Griffin
- University of Maryland, Department of Public and Community Health, College Park, Maryland 20742, 301-405-8546, FAX: 301-314-6598
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Sterk CE, Klein H, Elifson KW. Predictors of Condom-Related Attitudes among At-Risk Women. J Womens Health (Larchmt) 2004; 13:676-88. [PMID: 15333282 DOI: 10.1089/jwh.2004.13.676] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Negative attitudes toward using male condoms tend to be associated with higher rates of sexual risk. Little has been written about the factors that influence women's attitudes toward condom use, and this has implications for HIV intervention efforts. METHODS Two hundred fifty adult women considered to be at risk based on demographic and family characteristics and residing in the Atlanta, Georgia, metropolitan area were interviewed between August 1997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample done via targeted sampling and ethnographic mapping procedures. RESULTS Women held ambivalent to weakly positive attitudes toward condoms. Multivariate analysis revealed that five factors were associated with a greater frequency of engaging in seven specific types of sexual activities known to be associated with HIV transmission: condom-related attitudes (negative condom attitudes), marital status (being married vs. other marital status classification), religiosity (lesser), childhood physical abuse (greater), and the amount of illegal drug use (greater). Four significant predictors of condom attitudes were also identified: age (better condom attitudes among younger women), childhood neglect (more conductive condom attitudes among nonneglected women), self-esteem (more self-esteem = more favorable condom attitudes), and the number of drug problems experienced (more drug problems = more negative condom attitudes). CONCLUSIONS The more negative at-risk women's attitudes were regarding condom use, the more often they tended to engage in risky sex. Specific backgrounds and characteristics of the women were associated with greater/lesser condom use. To increase condom use, programs should consider targeting specific types of women as well as their specific attitudes toward condom use.
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Affiliation(s)
- Claire E Sterk
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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18
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Recommendations for incorporating human immunodeficiency virus (HIV) prevention into the medical care of persons living with HIV. Clin Infect Dis 2003; 38:104-21. [PMID: 14679456 DOI: 10.1086/380131] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Accepted: 09/05/2003] [Indexed: 01/14/2023] Open
Abstract
The estimated number of annual new human immunodeficiency virus (HIV) infections in the United States has remained at 40,000 for >10 years. Reducing the rate of transmission will require new strategies, including emphasis on prevention of transmission by HIV-infected persons. Medical care providers can affect HIV transmission by screening HIV-infected patients for risk behaviors, communicating prevention messages, discussing sexual and drug-use behaviors, reinforcing changes to safer behavior, referring patients for services such as substance abuse treatment, facilitating partner counseling and referral, and identifying and treating other sexually transmitted diseases. The Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) have recently collaborated to develop evidence-based recommendations for incorporating HIV prevention into the medical care of persons living with HIV. This article summarizes key aspects of the recommendations.
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Diamond C, Thiede H, Perdue T, Secura GM, Valleroy L, Mackellar D, Corey L. Viral hepatitis among young men who have sex with men: prevalence of infection, risk behaviors, and vaccination. Sex Transm Dis 2003; 30:425-32. [PMID: 12916134 DOI: 10.1097/00007435-200305000-00009] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Men who have sex with men (MSM) are at risk for acquiring hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). GOAL The goal was to describe the seroprevalence of and risk factors for viral hepatitis, the frequency of vaccination against HAV and HBV, and reasons for lack of vaccination among young MSM. STUDY DESIGN We performed hepatitis serologies on 833 MSM aged 15 to 29 years who attended public venues in King County, Washington. RESULTS While 14.6% were HAV-immune due to vaccination, 13.9% had prior HAV infection; 57.9% were susceptible and 13.5% had unclear status. While 24.5% were HBV-immune due to vaccination, 13.3% had prior HBV infection; 44.2% were susceptible and 18.0% had unclear status. Prior HBV infection was associated with prior HAV infection. Men unvaccinated against HAV or HBV were unaware of the vaccines or had never been offered vaccination or perceived themselves at low risk for infection. Among 10 HCV-seropositive men, 70.0% reported injection drug use. CONCLUSION MSM must be vaccinated at an early age to prevent acquisition of HAV and HBV. Given the frequency of coinfection with HAV and HBV, a combined vaccine would be useful in this population.
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Affiliation(s)
- Catherine Diamond
- University of California Irvine Medical Center, 101 City Drive South, Building 11, Route 81, Orange, CA 92868, USA.
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20
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Mantell JE, Hoffman S, Exner TM, Stein ZA, Atkins K. Family planning providers' perspectives on dual protection. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2003; 35:71-78. [PMID: 12729136 DOI: 10.1363/3507103] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
CONTEXT Family planning providers can play an important role in helping women to identify their risk of HIV and other sexually transmitted diseases (STDs) and to adopt preventive measures. In-depth investigation of providers' attitudes about approaches to STD risk assessment, contraceptive counseling and dual protection--concurrent protection from STDs and unintended pregnancy--has been limited. METHODS In semistructured interviews conducted in 1998, 22 health care providers from a large New York City agency offering contraceptive and STD services described how they balanced STD and pregnancy concerns, viewed risk assessment and assessed various contraceptive methods. RESULTS STD prevention was seen as an integral part of family planning counseling, and most providers believed that risk assessment should be conducted universally. Providers viewed dual protection as use of condoms along with an effective contraceptive; few advocated use of the male or female condom alone. The female condom was believed to be a disease prevention method of last resort and was considered appropriate only for specific groups of women. Although providers lacked understanding about the effectiveness of the female condom and how to counsel clients concerning its use, they expressed interest in learning more. CONCLUSIONS Training is needed to reduce providers' negative perceptions of the female condom and to reinforce the importance of individualized counseling tailored to women's specific circumstances. Studies are needed on how to encourage family planning providers to promote male and female condoms as effective contraceptive methods.
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Affiliation(s)
- Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, USA.
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21
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Margolis AD, Wolitski RJ, Parsons JT, Gómez CA. Are healthcare providers talking to HIV-seropositive patients about safer sex? AIDS 2001; 15:2335-7. [PMID: 11698714 DOI: 10.1097/00002030-200111230-00022] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A D Margolis
- Behavioral Intervention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control, Atlanta, GA, USA
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22
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Bluespruce J, Dodge WT, Grothaus L, Wheeler K, Rebolledo V, Carey JW, McAfee TA, Thompson RS. HIV prevention in primary care: impact of a clinical intervention. AIDS Patient Care STDS 2001; 15:243-53. [PMID: 11530765 DOI: 10.1089/10872910152050766] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Discomfort, lack of confidence in skills, and environmental constraints may cause primary care providers to miss opportunities to discuss human immunodeficiency virus (HIV) risk with patients. We used a systems approach to address both intrapersonal and environmental barriers to HIV risk assessment and prevention counseling in a managed care clinical setting. The design was one-group pretest/posttest. The study took place in two primary care clinics of a large Pacific Northwest managed care organization. Participants (n = 49) included physicians, physician assistants, nurse practitioners, registered nurses, and social workers. The intervention included training, clarification of provider/staff roles, assess to tools and materials, and reminders/reinforcers. Outcome measures were provider attitudes, beliefs, outcome expectations, knowledge, confidence in skills, and perceived supports and barriers, measured by written pretest/posttest surveys administered 12 months apart. Seven months after the most intensive part of the intervention, providers' attitudes and beliefs were more favorable to HIV risk assessment and prevention counseling. They were less likely to express frustration with high-risk patients (decrease from 100% to 79% agreement, p = 0.001) and more confident that their advice would be effective with gay men and single adult heterosexuals (p = 0.002 and 0.005, respectively). They reported more confidence in their training in sexual history taking (p = 0.0003) and their skills assessing readiness for change (p = 0.007), and more support in practice environments. This study demonstrated that it is possible to affect important personal and environmental factors that influence primary care providers' HIV prevention behavior using an interactive, real-world systems approach. Further research is needed on providers' impact on patient behavior.
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Affiliation(s)
- J Bluespruce
- Center for Health Promotion, Group Health Cooperative, Seattle, Washington 98168-2559, USA.
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