Improving HIV/STD prevention in the care of persons living with HIV through a national training program

A randomized clinical trial evaluating the impact of counselor training and patient feedback on substance use disorder patients' sexual risk behavior

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.

Predicting Clinical Practice Change: An Evaluation of Trainings on Sexually Transmitted Disease Knowledge, Diagnosis, and Treatment

BACKGROUND

Sexually transmitted disease clinical training for working professionals requires substantial time and resources. Understanding the predictors of change in worksite practices and barriers to change will allow educators, learners, and clinical leadership to aid in ensuring learned practices are implemented and barriers are addressed.

METHODS

Data for this analysis come from the first standardized national evaluation of a Centers for Disease Control and Prevention-funded clinical prevention training network, including precourse registration and responses to immediate postcourse (1-3 days) and 90-day postcourse evaluations from 187 courses. Univariate statistics describe the trainees and their workplace. Bivariate statistics describe their intention to change and actual change stratified by functional role and employment setting. Logistic regression identified predictors of self-reported changes in practice.

RESULTS

The strongest predictors for practice change included an intention to change and attendance at a training lasting 4 hours or more. Functional role was a weaker predictor of change in practice; employment setting did not predict change. More than half of the trainees (65.9%; n = 912) stated their intention to make a change in their practice immediately after training. At 90 days after a course, 62.4% (n = 863) reported making a practice change. Trainees that took courses lasting 4 hours or more reported making a change more often (70%) compared with trainees from shorter courses (53%). We also report on trainees' barriers to practice change.

CONCLUSIONS

Results suggest that longer trainings may result in more practice change than shorter trainings, recruitment of trainees should focus on those more likely to make a change in their practice, and future trainings should focus on organizational capacity building and assessing change at the organizational level.

The National Network of Sexually Transmitted Disease Clinical Prevention Training Centers Turns 40-A Look Back, a Look Ahead

Since 1979, the National Network of Sexually Transmitted Disease (STD) Clinical Prevention Training Centers (NNPTC) has provided state-of-the-art clinical and laboratory training for STD prevention across the United States. This article provides an overview of the history and activities of the NNPTC from its inception to present day, and emphasizes the important role the network continues to play in maintaining a high-quality STD clinical workforce. Over time, the NNPTC has responded to changing STD epidemiological patterns, technological advances, and increasing private-sector care-seeking for STDs. Its current structure of integrated regional and national training centers allows NNPTC members to provide dynamic, tailored responses to STD training needs across the country.

Increasing substance use disorder counselors' self-efficacy and skills in talking to patients about sex and HIV risk: A randomized training trial

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.