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Claus LE, Barton Laws M, Wilson IB, Han D, Saha S, Moore RD, Beach MC. Does the Quality of Behavior Change Counseling in Routine HIV Care Vary According to Topic and Demand? AIDS Behav 2023; 27:3780-3788. [PMID: 37792233 DOI: 10.1007/s10461-023-04135-8] [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] [Accepted: 05/15/2023] [Indexed: 10/05/2023]
Abstract
HIV clinicians face increasing time constraints. Our objective was to describe the prevalence and quality of behavior change counseling within routine HIV visits and to explore whether clinicians may provide lower quality counseling when facing increased counseling demands. We audio-recorded and transcribed encounters between 205 patients and 12 clinicians at an urban HIV primary care clinic. We identified and coded episodes of behavior change counseling to determine clinicians' consistency with motivational interviewing (MI) and used multi-level regression to evaluate counseling quality changes with each additional topic. Clinician counseling for at least one behavior was indicated in 92% of visits (mean 2.5/visit). Behavioral topics included antiretroviral medication adherence (80%, n = 163), appointment adherence (54%, n = 110), drug use (46%, n = 95), tobacco use (45%, n = 93), unsafe sex (43%, n = 89), weight management (39%, n = 80), and alcohol use (35%, n = 71). Clinician counseling was most MI-consistent when discussing drug and tobacco use and least consistent for medication and appointment adherence, unsafe sex, and alcohol use. In multilevel analyses, clinician counseling was significantly less MI-consistent (β = - 0.14, 95% CI - 0.29 to - 0.001) with each additional behavior change counseling need. This suggests that HIV ambulatory care be restructured to allocate increased time for patients with greater need for behavior change.
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Affiliation(s)
- Lauren E Claus
- Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21205, USA.
| | | | - Ira B Wilson
- Brown School of Public Health, Providence, RI, USA
| | - Dingfen Han
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Somnath Saha
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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2
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Circumstances Surrounding High-risk Sexual Experiences Among Primary Care Patients Living With and Without HIV. J Gen Intern Med 2018; 33:2163-2170. [PMID: 30251213 PMCID: PMC6258602 DOI: 10.1007/s11606-018-4675-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/12/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Rates of sexually transmitted infection (STI) are rising in the USA, yet STI risk remains under-addressed by providers, even in HIV care, and with high-risk patients. We interviewed primary care patients living with and without HIV regarding circumstances surrounding sexual risk behavior to identify opportunities for providers to address and reduce STI risk. METHODS We conducted semi-structured 1:1 interviews with patients living with and without HIV reporting ≥ 1 sex partner and varying STI exposure risk in the past 12 months from four geographically diverse US HIV and primary care clinics. We audio-recorded, transcribed, and coded interviews by circumstance type, using double-coding to ensure inter-coder reliability. We used Fisher's exact and T tests to determine associations with demographic/risk factors. RESULTS Patients (n = 91) identified a mean of 3 of 11 circumstances. These included substance use (54%), desire for physical/emotional intimacy (48%), lack of HIV/STI status disclosure (44%), psychological drivers (i.e., coping, depression; 38%), personal dislike of condoms (22%), partner condom dislike/refusal (19%), receiving payment for sex (13%), and condom unavailability (9%). Higher proportions of those who were high STI-exposure risk patients, defined as those with ≥ 2 sex partners in the past 3 months reporting never or sometimes using condoms, reported disliking condoms (p = .006); higher proportions of the high-risk and moderate-risk (≥ 2 partners and condom use "most of the time") groups reported substance use as a circumstance (p = .04). CONCLUSION Circumstances surrounding perceived STI exposure risk were diverse, often overlapping, and dependent on internal, environmental, and partner-related factors and inadequate communication. Meaningful care-based interventions regarding HIV/STI transmission behavior must address the diversity and interplay of these factors.
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3
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Fredericksen RJ, Mayer KH, Gibbons LE, Edwards TC, Yang FM, Walcott M, Brown S, Dant L, Loo S, Gutierrez C, Paez E, Fitzsimmons E, Wu AW, Mugavero MJ, Mathews WC, Lober WB, Kitahata MM, Patrick DL, Crane PK, Crane HM. Development and Content Validation of a Patient-Reported Sexual Risk Measure for Use in Primary Care. J Gen Intern Med 2018; 33:1661-1668. [PMID: 29845470 PMCID: PMC6153230 DOI: 10.1007/s11606-018-4496-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/21/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools. OBJECTIVE To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure. DESIGN Qualitative item development/quantitative instrument validation. PARTICIPANTS We developed SRBI items based on patient interviews (n = 128) at four geographically diverse US primary care clinics. Patients were diverse in gender identity, sex, sexual orientation, age, race/ethnicity, and HIV status. We compared sexual risk behavior identified by the SRBI and the Risk Assessment Battery (RAB) among patients (n = 422). APPROACH We constructed an item pool based on validated measures of sexual risk, developed an in-depth interview guide based on pool content, and used interviews to elicit new sexual risk concepts. We coded concepts, matched them to item pool content, and developed new content where needed. A provider team evaluated item clinical relevance. We conducted cognitive interviews to assess item comprehensibility. We administered the SRBI and the RAB to patients. KEY RESULTS Common, clinically relevant concepts in the SRBI included number of sex partners; partner HIV status; partner use of antiretroviral medication (ART)/pre-exposure prophylaxis (PrEP); and recent sex without barrier protection, direction of anal sex, and concern regarding HIV/STI exposure. While 90% reported inconsistent condom use on the RAB, same-day SRBI administration revealed that for over one third, all their partners were on ART/PrEP. CONCLUSION The SRBI is a brief, skip-patterned, clinically relevant measure that ascertains sexual risk behavior across sex, sexual orientation, gender identity, partner HIV serostatus, and partner treatment status, furnishing providers with context to determine gradations of risk for HIV/STI.
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Affiliation(s)
| | | | - Laura E Gibbons
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Todd C Edwards
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | | | | | - Sharon Brown
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Lydia Dant
- Fenway Community Health, Boston, MA, USA
| | | | | | - Edgar Paez
- University of California, San Diego, CA, USA
| | - Emma Fitzsimmons
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Albert W Wu
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | - William B Lober
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Mari M Kitahata
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Donald L Patrick
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Paul K Crane
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Heidi M Crane
- Center for AIDS Research, University of Washington, Seattle, WA, USA
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Sayan M, Hınçal E, Şanlıdağ T, Kaymakamzade B, Sa’ad FT, Baba IA. Dynamics of HIV/AIDS in Turkey from 1985 to 2016. ACTA ACUST UNITED AC 2017; 52:711-723. [PMID: 32214507 PMCID: PMC7088870 DOI: 10.1007/s11135-017-0648-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this paper, we formulated a mathematical model that studies the dynamics of HIV/AIDS in Turkey from 1985 to 2016. We find two equilibrium points, disease free equilibrium and endemic equilibrium. Global stability analysis of the equilibria was conducted using Lyapunov function which depends on the basic reproduction ratio R0. If R0 < 1, the disease free equilibrium point is globally asymptotically stable, and if R0 ≥ 1 the endemic equilibrium point is globally asymptotically stable. We computed and predicted the basic reproduction ratios across all the years. It was found out that there were flaws in the exact values of R0 which is related to the poor registration system of HIV/AIDS in Turkey. Hence, there is need for the government to improve the system in order to cover the actual cases of the disease. The increase of the basic reproduction ratio over the years also shows the need for the relevant authorities to adopt appropriate control measures in combating the disease.
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Affiliation(s)
- Murat Sayan
- PCR Unit, Clinical Laboratory, Faculty of Medicine, Kocaeli University, Izmit, Kocaeli Turkey
| | - Evren Hınçal
- Department of Mathematics, Near East University, Nicosia, Northern Cyprus Turkey
| | - Tamer Şanlıdağ
- Department of Medical Microbiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
- Research Center of Experimental Health Sciences, Near East University, Nicosia, Northern Cyprus Turkey
| | - Bilgen Kaymakamzade
- Department of Mathematics, Near East University, Nicosia, Northern Cyprus Turkey
| | - Farouk Tijjani Sa’ad
- Department of Mathematics, Near East University, Nicosia, Northern Cyprus Turkey
| | - Isa Abdullahi Baba
- Department of Mathematics, Near East University, Nicosia, Northern Cyprus Turkey
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Crane HM, Crane PK, Tufano JT, Ralston JD, Wilson IB, Brown TD, Davis TE, Smith LF, Lober WB, McReynolds J, Dhanireddy S, Harrington RD, Rodriguez CV, Nance RM, Delaney JAC, Safren SA, Kitahata MM, Fredericksen RJ. HIV Provider Documentation and Actions Following Patient Reports of At-risk Behaviors and Conditions When Identified by a Web-Based Point-of-Care Assessment. AIDS Behav 2017; 21:3111-3121. [PMID: 28205041 DOI: 10.1007/s10461-017-1718-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We compared same-day provider medical record documentation and interventions addressing depression and risk behaviors before and after delivering point-of-care patient-reported outcomes (PROs) feedback for patients who self-reported clinically relevant levels of depression or risk behaviors. During the study period (1 January 2006-15 October 2010), 2289 PRO assessments were completed by HIV-infected patients. Comparing the 8 months before versus after feedback implementation, providers were more likely to document depression (74% before vs. 87% after feedback, p = 0.02) in patients with moderate-to-severe depression (n = 317 assessments), at-risk alcohol use (41 vs. 64%, p = 0.04, n = 155) and substance use (60 vs. 80%, p = 0.004, n = 212). Providers were less likely to incorrectly document good adherence among patients with inadequate adherence after feedback (42 vs. 24%, p = 0.02, n = 205). While PRO feedback of depression and adherence were followed by increased provider intervention, other domains were not. Further investigation of factors associated with the gap between awareness and intervention are needed in order to bridge this divide.
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de Munnik S, Vervoort SCJM, Ammerlaan HSM, Kok G, den Daas C. From intention to STI prevention: An online questionnaire on barriers and facilitators for discussing sexual risk behaviour among HIV nurses. J Adv Nurs 2017; 73:2953-2961. [PMID: 28661015 DOI: 10.1111/jan.13372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Abstract
AIMS We aimed to elucidate facilitators and barriers that HIV nurses experience in discussing sexual risk behaviour with HIV-positive men who have sex with men, using variables from a previous qualitative study and the theory of planned behaviour. BACKGROUND HIV-positive men who have sex with men are frequently diagnosed with sexually transmitted infections, which can be reduced if HIV nurses discuss sexual risk behaviour. DESIGN An online questionnaire was disseminated in April 2015 among all HIV nurses in the Netherlands. METHODS We assessed variables, such as attitudes, shame, ability, knowledge and time concerns. A regression analysis was conducted with "intention to discuss sexual risk behaviour" as an outcome variable. RESULTS The questionnaire was completed by 60 of 79 HIV nurses. Overall, participants reported high intentions to discuss sexual risk behaviour, and 38% of the variance was explained by attitude, sexual preference, knowing ways to introduce the topic and experiencing enough time or viewing it as a priority. In addition, high intenders significantly differed from low intenders in "experienced shame," "relation with patients," "non-verbal communication," "subjective norm" and "knowledge." CONCLUSION Improving sexual health in HIV care translates into improving opportunities and the facilitating factors in initiating the discussion of sexual risk behaviour rather than removing barriers HIV nurses experience. Interventions should mainly focus on improving the HIV nurses' perceived ability to initiate the topic of sexual risk behaviour and to utilize the jargon and terminology that is commonly used among men who have sex with men.
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Affiliation(s)
- Suzanne de Munnik
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands.,National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | | | - Heidi S M Ammerlaan
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Gerjo Kok
- Department of Applied Psychology, Maastricht University, Maastricht, The Netherlands
| | - Chantal den Daas
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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McKinstry LA, Zerbe A, Hanscom B, Farrior J, Kurth AE, Stanton J, Li M, Elion R, Leider J, Branson B, El-Sadr WM. A Randomized-Controlled Trial of Computer-based Prevention Counseling for HIV-Positive Persons (HPTN 065). ACTA ACUST UNITED AC 2017; 8. [PMID: 28966842 PMCID: PMC5619875 DOI: 10.4172/2155-6113.1000714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Decreasing the risk of HIV transmission from HIV-positive individuals is an important public health priority. We evaluated the effectiveness of a computer-based sexual risk reduction counseling intervention (CARE+) among HIV-positive persons enrolled in care. METHODS HIV-positive eligible participants (N=1075) were enrolled from 11 care sites in the Bronx, NY and Washington, DC and randomized 1:1 to either a tablet-based self-administered CARE+ intervention or standard of care (SOC). The primary outcome was the proportion of participants reporting any unprotected vaginal/anal sex at last sex, among all partners, HIV-negative or HIV-unknown-status partners and for primary and non-primary partners. RESULTS At baseline, 7% of participants in both arms reported unprotected sex with an HIV-negative or HIV-unknown-status partner, while 13% in the CARE+ arm and 17% in the SOC arm reported unprotected sex with any partner. Most participants (88%) were on antiretroviral therapy (ART) at baseline. There was no significant difference in changes over time in unprotected vaginal/anal sex between the CARE+ and SOC arms for any partners (p=0.67) or either HIV-negative or HIV-unknown-status partners (p=0.40). At the Month 12 visit, most participants (85%) either strongly agreed or agreed that computer counseling would be a good addition to in-person counseling by a provider. CONCLUSION The CARE+ intervention was not effective at reducing sexual risk behaviors among HIV-positive patients in care, most of whom were on ART. Further research may be warranted around the utility of computer-based counseling for HIV prevention.
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Affiliation(s)
- Laura A McKinstry
- Statistical Center for AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Brett Hanscom
- Statistical Center for AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, USA
| | | | | | | | - Maoji Li
- Statistical Center for AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Rick Elion
- District of Columbia District of Health STD/HIV Research Program, Washington, USA
| | - Jason Leider
- North Bronx Health Care Network, New York, NY, USA
| | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
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Kemp CG, de Kadt J, Pillay E, Gilvydis JM, Naidoo E, Grignon J, Weaver MR. Pre/post evaluation of a pilot prevention with positives training program for healthcare providers in North West Province, Republic of South Africa. BMC Health Serv Res 2017; 17:316. [PMID: 28464926 PMCID: PMC5414361 DOI: 10.1186/s12913-017-2263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention interventions for people living with HIV/AIDS are an important component of HIV programs. We report the results of a pilot evaluation of a four-hour, clinic-based training for healthcare providers in South Africa on HIV prevention assessments and messages. This pre/post pilot evaluation examined whether the training was associated with providers delivering more prevention messages. METHODS Seventy providers were trained at four public primary care clinics with a high volume of HIV patients. Pre- and post-training patient exit surveys were conducted using Audio-Computer Assisted Structured Interviews. Seven provider appropriate messaging outcomes and one summary provider outcome were compared pre- and post-training using Poisson regression. RESULTS Four hundred fifty-nine patients pre-training and 405 post-training with known HIV status were interviewed, including 175 and 176 HIV positive patients respectively. Among HIV positive patients, delivery of all appropriate messages by providers declined post-training. The summary outcome decreased from 56 to 50%; adjusted rate ratio 0.92 (95% CI = 0.87-0.97). Sensitivity analyses adjusting for training coverage and time since training detected fewer declines. Among HIV negative patients the summary score was stable at 32% pre- and post-training; adjusted rate ratio 1.05 (95% CI = 0.98-1.12). CONCLUSIONS Surprisingly, this training was associated with a decrease in prevention messages delivered to HIV positive patients by providers. Limited training coverage and delays between training and post-training survey may partially account for this apparent decrease. A more targeted approach to prevention messages may be more effective.
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Affiliation(s)
- Christopher G. Kemp
- Department of Global Health, University of Washington, Ninth and Jefferson Building, 13th Floor, Box 359932, 908 Jefferson Street, Seattle, WA 98104 USA
- International Training and Education Center for Health (I-TECH), University of Washington, 908 Jefferson Street, Seattle, WA 98104 USA
| | - Julia de Kadt
- I-TECH South Africa, 232 Bronkhorst St, Suite 203 Optiplan House, Nieuw Muckleneuk, Pretoria, South Africa
| | - Erushka Pillay
- I-TECH South Africa, 232 Bronkhorst St, Suite 203 Optiplan House, Nieuw Muckleneuk, Pretoria, South Africa
- Project Hope, 255 Carter Hall Lane, PO Box 250, Millwood, VA 22646 USA
| | - Jennifer M. Gilvydis
- Department of Global Health, University of Washington, Ninth and Jefferson Building, 13th Floor, Box 359932, 908 Jefferson Street, Seattle, WA 98104 USA
- International Training and Education Center for Health (I-TECH), University of Washington, 908 Jefferson Street, Seattle, WA 98104 USA
| | - Evasen Naidoo
- I-TECH South Africa, 232 Bronkhorst St, Suite 203 Optiplan House, Nieuw Muckleneuk, Pretoria, South Africa
| | - Jessica Grignon
- Department of Global Health, University of Washington, Ninth and Jefferson Building, 13th Floor, Box 359932, 908 Jefferson Street, Seattle, WA 98104 USA
- I-TECH South Africa, 232 Bronkhorst St, Suite 203 Optiplan House, Nieuw Muckleneuk, Pretoria, South Africa
| | - Marcia R. Weaver
- Department of Global Health, University of Washington, Ninth and Jefferson Building, 13th Floor, Box 359932, 908 Jefferson Street, Seattle, WA 98104 USA
- International Training and Education Center for Health (I-TECH), University of Washington, 908 Jefferson Street, Seattle, WA 98104 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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10
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Fredericksen RJ, Tufano J, Ralston J, McReynolds J, Stewart M, Lober WB, Mayer KH, Mathews WC, Mugavero MJ, Crane PK, Crane HM. Provider perceptions of the value of same-day, electronic patient-reported measures for use in clinical HIV care. AIDS Care 2016; 28:1428-33. [PMID: 27237187 DOI: 10.1080/09540121.2016.1189501] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions, reduce omissions in care, and improve patient-provider communication. However, provider acceptability of PROs and their use in clinical HIV care is not well known. We interviewed providers (n = 27) from four geographically diverse HIV and community care clinics in the US that have integrated PROs into routine HIV care, querying perceived value, challenges, and use of PRO data. Perceived benefits included the ability of PROs to identify less-observable behaviors and conditions, particularly suicidal ideation, depression, and substance use; usefulness in agenda setting prior to a visit; and reduction of social desirability bias in patient-provider communication. Challenges included initial flow integration issues and ease of interpretation of PRO feedback. Providers value same-day, electronic patient-reported measures for use in clinical HIV care with the condition that PROs are (1) tailored to be the most clinically relevant to their population; (2) well integrated into clinic flow; and (3) easy to interpret, highlighting chief patient concerns and changes over time.
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Affiliation(s)
- R J Fredericksen
- a Center for AIDS Research , University of Washington , Seattle , WA , USA
| | - J Tufano
- b Department of Medicine , University of Washington , Seattle , WA , USA
| | - J Ralston
- c Department of Internal Medicine , Group Health Research Institute , Seattle , WA , USA
| | - J McReynolds
- d Biobehavioral Nursing and Health Systems , University of Washington , Seattle , WA , USA
| | - M Stewart
- d Biobehavioral Nursing and Health Systems , University of Washington , Seattle , WA , USA
| | - W B Lober
- e Biomedical and Health Informatics , University of Washington , Seattle , WA , USA
| | - K H Mayer
- f Fenway Community Health , Boston , MA , USA
| | - W C Mathews
- g Owen Clinic , UCSD Medical Center , San Diego , CA , USA
| | - M J Mugavero
- h Department of Medicine/Infectious Diseases , University of Alabama at Birmingham , Birmingham , AL , USA
| | - P K Crane
- b Department of Medicine , University of Washington , Seattle , WA , USA
| | - H M Crane
- i Department of Medicine, Harborview Medical Center , University of Washington , Seattle , WA , USA
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11
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Fredericksen RJ, Edwards TC, Merlin JS, Gibbons LE, Rao D, Batey DS, Dant L, Páez E, Church A, Crane PK, Crane HM, Patrick DL. Patient and provider priorities for self-reported domains of HIV clinical care. AIDS Care 2015; 27:1255-64. [PMID: 26304263 DOI: 10.1080/09540121.2015.1050983] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We sought to understand how HIV-infected patients, their providers, and HIV care researchers prioritize self-reported domains of clinical care. Participants rank-ordered two lists of domains. A modified Delphi process was used for providers and researchers. Approximately 25% of patients were interviewed to discuss rationale for rank order choices. List 1 included anger, anxiety, depression, fatigue, physical function, pain, and sleep disturbance. List 2 included alcohol abuse, cognitive function, HIV stigma, HIV and treatment symptoms, medication adherence, positive affect, sexual risk behavior, sexual function, social roles, spirituality/meaning of life, and substance abuse. Seventy-four providers, 80 HIV care researchers, and 66 patients participated. Patients ranked context-based domains, such as HIV stigma, more highly than providers, while health behaviors, such as drug or alcohol use, ranked lower. Patients described a need to address wider-context challenges such as HIV stigma in order to positively impact health behaviors. Divergent patient and provider priorities highlight the importance of incorporating views from all stakeholders and suggests the need for a care approach that more effectively addresses contextual barriers to adverse health behaviors.
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Affiliation(s)
- Rob J Fredericksen
- a Center for AIDS Research , University of Washington , Seattle , WA 98104 , USA
| | - Todd C Edwards
- b Seattle Quality of Life Group , University of Washington , Seattle , WA 98104 , USA
| | - Jessica S Merlin
- c School of Medicine, Division of Infectious Diseases , University of Alabama at Birmingham , Birmingham , AL 35294 , USA
| | - Laura E Gibbons
- d Department of General Internal Medicine , University of Washington , Seattle , WA 98104 , USA
| | - Deepa Rao
- e Department of Global Health , University of Washington , Seattle , WA 98104 , USA
| | - D Scott Batey
- f Department of Medicine, Division of Infectious Diseases, Research and Informatics Service Center , University of Alabama at Birmingham , Birmingham , AL 35294 , USA
| | - Lydia Dant
- g The Fenway Institute , Boston , MA 02215 , USA
| | - Edgar Páez
- h UCSD Medical Center - Owen Clinic , San Diego , CA 92103-8681 , USA
| | - Anna Church
- a Center for AIDS Research , University of Washington , Seattle , WA 98104 , USA
| | - Paul K Crane
- i Internal Medicine , University of Washington , Seattle , WA 98104 , USA
| | - Heidi M Crane
- j Department of Medicine , University of Washington , Seattle , WA 98104 , USA
| | - Donald L Patrick
- b Seattle Quality of Life Group , University of Washington , Seattle , WA 98104 , USA
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Audet CM, Gutin SA, Blevins M, Chiau E, Alvim F, Jose E, Vaz LME, Shepherd BE, Dawson Rose C. The Impact of Visual Aids and Enhanced Training on the Delivery of Positive Health, Dignity, and Prevention Messages to Adult Patients Living with HIV in Rural North Central Mozambique. PLoS One 2015; 10:e0130676. [PMID: 26147115 PMCID: PMC4493138 DOI: 10.1371/journal.pone.0130676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/24/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction Positive health, dignity, and prevention (PHDP) interventions target people living with HIV and AIDS (PLHIV) to promote well-being and prevent onward transmission. Concern that increased life expectancy and improved well-being would lead to increased risky sexual behaviour and subsequent HIV transmission motivated researchers to test novel strategies to support treatment adherence, encourage safer sex, STI treatment and partner testing, prevention of mother to child transmission, and support uptake of family planning. Methods We assessed the number and type of PHDP messages delivered to PLHIV before and after the implementation of an educational intervention for health providers combined with the distribution of visual job aids and monthly technical assistance. Results From April 21, 2013 to March 20, 2014, we documented 54,731 clinical encounters at three rural health centres in Zambézia province, Mozambique from 9,248 unique patients. The percentage of patients who received all seven PHDP messages during their last three visits was 1.9% pre-intervention vs. 13.6% post- intervention (p=<0.001). Younger patients (25 years vs. 35) and those with a recent HIV diagnosis (two weeks vs. two years) had higher odds of receiving any PHDP message (Odds Ratio [OR]: 1.22 and 2.79, respectively). Patients >59 days late collecting medications were not more likely to receive adherence messages than adherent patients (p=0.17). Discussion Targeting HIV prevention efforts to PLHIV is an effective HIV prevention approach to eliminate HIV transmission. Despite intensive training and support, PHDP message delivery remained unacceptably low in rural Mozambique. Patients at high risk for treatment abandonment were not more likely to be counselled about adherence and support measures, something that needs to be addressed. Conclusions We need to develop novel strategies to motivate health care providers to deliver these messages more consistently to all patients and develop a system that assists counsellors and clinicians to quickly and effectively determine which messages should be delivered.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Departments of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail:
| | - Sarah A. Gutin
- Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Meridith Blevins
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Elvino Chiau
- Friends in Global Health, Maputo and Quelimane, Mozambique
| | - Fernanda Alvim
- Friends in Global Health, Maputo and Quelimane, Mozambique
| | - Eurico Jose
- Friends in Global Health, Maputo and Quelimane, Mozambique
| | - Lara M. E. Vaz
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Bryan E Shepherd
- Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
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Kose S, Mandiracioglu A, Mermut G, Kaptan F, Ozbel Y. The Social and Health Problems of People Living with HIV/AIDS in Izmir, Turkey. Eurasian J Med 2015; 44:32-9. [PMID: 25610202 DOI: 10.5152/eajm.2012.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 10/27/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe how AIDS, as well as the stigma associated with it, affects the lives of HIV positive patients and their family members. MATERIALS AND METHODS Three large state hospitals in the metropolitan area of Izmir participated in the study. Six focus groups were conducted with people infected with HIV (n=32) and their family members (n=11). Participants were asked to fill out a questionnaire to assess their HIV/AIDS knowledge and to convey how the stigma had affected them. RESULTS The most important problems identified were society and work-related social problems and access to health services. The patients and their family members stated that education was needed to correct misconceptions about HIV and to help them cope with related problems. We found that patients and their family members were sensitive about disclosure. CONCLUSION We determined the education, counseling and support needs of HIV-infected patients and their families. Additionally, we found that health personnel who monitor the patients should make more efforts on patients' education and counselling.
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Affiliation(s)
- Sukran Kose
- Clinic of Infectious Diseases, Ministry of Health Tepecik Hospital, Izmir, Turkey
| | - Aliye Mandiracioglu
- Department of Public Health, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gulsen Mermut
- Clinic of Infectious Diseases, Ministry of Health Bozyaka Hospital, Izmir, Turkey
| | - Figen Kaptan
- Clinic of Infectious Diseases, Ministry of Health Ataturk Hospital, Izmir, Turkey
| | - Yusuf Ozbel
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
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Mgbere O, Rodriguez-Barradas MC, Bell TK, Khuwaja S, Arafat R, Essien EJ, Singh M, Simmons P, Aguilar J. Frequency and Determinants of Preventive Care Counseling by HIV Medical Care Providers during Encounters with Newly Diagnosed and Established HIV-Infected Patients. J Int Assoc Provid AIDS Care 2014; 15:215-27. [PMID: 25361557 DOI: 10.1177/2325957414556352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study evaluates the frequency and determinants of preventive care counseling by HIV medical care providers (HMCPs) during encounters with newly diagnosed and established HIV-infected patients. Data used were from a probability sample of HMCPs in Houston/Harris County, Texas, surveyed in 2009. Overall, HMCPs offered more preventive care counseling to newly diagnosed than the established patients (adjusted odds ratio [AOR] = 7.28; 95% confidence interval [CI] = 2.86-16.80). They were more likely to counsel newly diagnosed patients than the established ones on medication and adherence (AOR = 14.70; 95% CI = 1.24-24.94), HIV risk reduction (AOR = 5.91; 95% CI = 0.48-7.13), and disease screening (AOR = 7.20; 95% CI = 0.72-11.81). HIV medical care providers who were less than 45 years of age, infectious disease specialists, and had less than 30 minutes of encounter time were less likely to counsel patients regardless of the status. Our findings suggest the need for HMCPs to improve their preventive care counseling efforts, in order to help patients build skills for adopting and maintaining safe behavior that could assist in reducing the risk of HIV transmission.
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Affiliation(s)
- Osaro Mgbere
- Bureau of Epidemiology, Office of Surveillance and Public Health Preparedness, Houston Department of Health and Human Services, Houston, TX, USA Institute of Community Health, University of Houston College of Pharmacy, Texas Medical Center, Houston, TX, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center, Houston, TX, USA Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Tanvir K Bell
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Health Science Center, Houston, TX, USA
| | - Salma Khuwaja
- Bureau of Epidemiology, Office of Surveillance and Public Health Preparedness, Houston Department of Health and Human Services, Houston, TX, USA
| | - Raouf Arafat
- Bureau of Epidemiology, Office of Surveillance and Public Health Preparedness, Houston Department of Health and Human Services, Houston, TX, USA
| | - Ekere J Essien
- Institute of Community Health, University of Houston College of Pharmacy, Texas Medical Center, Houston, TX, USA
| | - Mamta Singh
- Bureau of Epidemiology, Office of Surveillance and Public Health Preparedness, Houston Department of Health and Human Services, Houston, TX, USA
| | - Paul Simmons
- Legacy Community Health Services, Montrose Campus, Houston, TX, USA
| | - Jonathan Aguilar
- Bureau of Epidemiology, Office of Surveillance and Public Health Preparedness, Houston Department of Health and Human Services, Houston, TX, USA
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A systematic review of interventions for reducing HIV risk behaviors among people living with HIV in the United States, 1988-2012. AIDS 2014; 28:633-56. [PMID: 24983541 DOI: 10.1097/qad.0000000000000108] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To conduct a systematic review to examine interventions for reducing HIV risk behaviors among people living with HIV (PLWH) in the United States. METHODS Systematic searches included electronic databases from 1988 to 2012, hand searches of journals, reference lists of articles, and HIV/AIDS Internet listservs. Each eligible study was evaluated against the established criteria on study design, implementation, analysis, and strength of findings to assess the risk of bias and intervention effects. RESULTS Forty-eight studies were evaluated. Fourteen studies (29%) with both low risk of bias and significant positive intervention effects in reducing HIV transmission risk behaviors were classified as evidence-based interventions (EBIs). Thirty-four studies were classified as non-EBIs due to high risk of bias or nonsignificant positive intervention effects. EBIs varied in delivery from brief prevention messages to intensive multisession interventions. The key components of EBIs included addressing HIV risk reduction behaviors, motivation for behavioral change, misconception about HIV, and issues related to mental health, medication adherence, and HIV transmission risk behavior. CONCLUSION Moving evidence-based prevention for PLWH into practice is an important step in making a greater impact on the HIV epidemic. Efficacious EBIs can serve as model programs for providers in healthcare and nonhealthcare settings looking to implement evidence-based HIV prevention. Clinics and public health agencies at the state, local, and federal levels can use the results of this review as a resource when making decisions that meet the needs of PLWH to achieve the greatest impact on the HIV epidemic.
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Mizuno Y, Zhu J, Crepaz N, Beer L, Purcell DW, Johnson CH, Valverde EE, Skarbinski J. Receipt of HIV/STD prevention counseling by HIV-infected adults receiving medical care in the United States. AIDS 2014; 28:407-15. [PMID: 24056066 DOI: 10.1097/qad.0000000000000057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Guidelines recommend risk-reduction counseling by HIV providers to all HIV-infected persons. Among HIV-infected adults receiving medical care in the United States, we estimated prevalence of exposure to three types of HIV/sexually transmitted disease (STD) risk-reduction interventions and described the characteristics of persons who received these interventions. DESIGN Data were from the Medical Monitoring Project (MMP), a supplemental HIV surveillance system designed to produce nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States. METHODS Descriptive analyses were conducted to estimate the exposure to each type of HIV/STD risk-reduction intervention. Bivariate and multivariable analyses were conducted to assess associations between the selected correlates with each exposure variable. RESULTS About 44% of participants reported a one-on-one conversation with a healthcare provider about HIV/STD prevention, 30% with a prevention program worker, 16% reported participation in a small group risk-reduction intervention, and 52% reported receiving at least one of the three interventions in the past 12 months. Minority race/ethnicity, low income, and risky sexual behavior consistently predicted greater intervention exposure. However, 39% of persons who reported risky sex did not receive any HIV/STD risk-reduction interventions. CONCLUSIONS HIV-infected persons in care with fewer resources or those who engaged in risk behaviors were more likely to receive HIV/STD risk-reduction interventions. However, less than half of HIV-infected persons in care received HIV/STD prevention counseling from their provider, an intervention that has been shown to be effective and is supported by guidelines.
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17
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Flickinger TE, Rose G, Wilson IB, Wolfe H, Saha S, Korthuis PT, Massa M, Berry S, Laws MB, Sharp V, Moore RD, Beach MC. Motivational interviewing by HIV care providers is associated with patient intentions to reduce unsafe sexual behavior. PATIENT EDUCATION AND COUNSELING 2013; 93:122-9. [PMID: 23647982 PMCID: PMC3759567 DOI: 10.1016/j.pec.2013.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 03/15/2013] [Accepted: 04/07/2013] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Motivational interviewing (MI) can promote behavior change, but HIV care providers rarely have training in MI. Little is known about the use of MI-consistent behavior among untrained providers. This study examines the prevalence of such behaviors and their association with patient intentions to reduce high-risk sexual behavior. METHODS Audio-recorded visits between HIV-infected patients and their healthcare providers were searched for counseling dialog regarding sexual behavior. The association of providers' MI-consistence with patients' statements about behavior change was assessed. RESULTS Of 417 total encounters, 27 met inclusion criteria. The odds of patient commitment to change were higher when providers used more reflections (p=0.017), used more MI consistent utterances (p=0.044), demonstrated more empathy (p=0.049), and spent more time discussing sexual behavior (p=0.023). Patients gave more statements in favor of change (change talk) when providers used more reflections (p<0.001) and more empathy (p<0.001), even after adjusting for length of relevant dialog. CONCLUSION Untrained HIV providers do not consistently use MI techniques when counseling patients about sexual risk reduction. However, when they do, their patients are more likely to express intentions to reduce sexual risk behavior. PRACTICE IMPLICATIONS MI holds promise as one strategy to reduce transmission of HIV and other sexually transmitted infections.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Sandfort TGM, Collier KL, Grossberg R. Addressing sexual problems in HIV primary care: experiences from patients. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1357-1368. [PMID: 22965768 PMCID: PMC3548998 DOI: 10.1007/s10508-012-0009-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/11/2012] [Accepted: 06/22/2012] [Indexed: 06/01/2023]
Abstract
Evidence suggests that sexual problems are common among people living with HIV and may be related to sexual risk taking and treatment adherence. This study explored the extent to which sexual problems experienced by people with HIV are addressed in primary care as well as how primary care responses to sexual problems are experienced by patients. Structured interviews were conducted with 60 patients at an urban HIV clinic. The average age of the participants (37 male, 23 female) was 45.8 years (SD = 7.9). Sexual problems were common. The most common sexual problem experienced in the past year was a lack of interest in sex (53.3 % reported) and the least common problem was painful intercourse (reported by 20 %). There were no gender differences in reports of sexual problems, except that painful intercourse was more frequently reported by women than men. Relatively few individuals who experienced sexual problems had discussed them with their provider, but these individuals were generally pleased with the counseling they had received and could identify several factors that facilitated a positive patient-provider interaction. Those who offer primary care services to people with HIV should be aware of sexual problems their patients may be experiencing and should feel confident in their ability to successfully address these problems. Providers may need additional training in order to adequately address sexual problems among people with HIV in primary care settings.
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Affiliation(s)
- Theo G M Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA,
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Flickinger TE, Berry S, Korthuis PT, Saha S, Laws MB, Sharp V, Moore RD, Beach MC. Counseling to reduce high-risk sexual behavior in HIV care: a multi-center, direct observation study. AIDS Patient Care STDS 2013; 27:416-24. [PMID: 23802144 PMCID: PMC3704109 DOI: 10.1089/apc.2012.0426] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A key opportunity to reduce HIV transmission lies with healthcare providers counseling HIV-infected patients about safer sex. We audio-recorded and transcribed clinical encounters between 45 healthcare providers and 417 of their HIV-infected patients at four outpatient sites in the United States. We used logistic regressions to evaluate associations between patient and provider characteristics, and the occurrence of discussion (any talk about sex) and counseling (advice about safer sex). Of the 417 encounters, discussion of sex occurred in 187 (45% of encounters, 95% CI: 40-50%). Counseling occurred for 49% (95% CI: 35-63%) of patients reporting unsafe sex. Discussion of sex was more likely with younger or less-educated patients and with less cultural difference between patient and provider, while counseling was associated with greater provider mindfulness and lower provider empathy. These findings suggest targets to improve communication regarding sexual risk reduction in HIV care.
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Affiliation(s)
- Tabor E Flickinger
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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20
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Koester KA, Maiorana A, Morin SF, Rose CD, Shade S, Myers JJ. People living with HIV are receptive to HIV prevention interventions in clinical settings: a qualitative evaluation. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:295-308. [PMID: 22827900 DOI: 10.1521/aeap.2012.24.4.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In the United States, HIV prevention services are increasingly being offered in the context of healthcare settings. This includes prioritizing prevention services for people living with HIV (PLWH), otherwise known as "prevention with positives." We conducted sixty in-depth interviews to explore patients' perceptions of clinic-based HIV prevention interventions targeting people living with HIV. The majority of patients were receptive to the prevention interventions. Patients described experiencing feeling fulfilled by communicating about issues related to HIV prevention when the conversations were specific to their situation and with an interventionist who was objective, yet empathic and non-judgmental. Provider-delivered interventions opened up new areas of prevention discussions with patients. Specialist-delivered interventions, specifically group-level interventions, provided opportunities to integrate participants into social networks that in turn provided social support and a reduction in social isolation. HIV prevention counseling benefited patients regardless of risk status.
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Affiliation(s)
- Kimberly A Koester
- AIDS Policy Research Center, Center for AIDS Prevention Studies, Department of Medicine, at the University of California in San Francisco, San Francisco, CA 94105, USA.
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Kurth AE, McClelland L, Wanje G, Ghee AE, Peshu N, Mutunga E, Jaoko W, Storwick M, Holmes KK, McClelland S. An integrated approach for antiretroviral adherence and secondary HIV transmission risk-reduction support by nurses in Kenya. J Assoc Nurses AIDS Care 2012; 23:146-54. [PMID: 21803605 PMCID: PMC4018811 DOI: 10.1016/j.jana.2011.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 05/02/2011] [Indexed: 11/17/2022]
Abstract
Ongoing antiretroviral therapy (ART) adherence and secondary HIV transmission-risk reduction (positive prevention) support are needed in resource-limited settings. We evaluated a nurse-delivered counseling intervention in Kenya. We trained 90 nurses on a brief counseling algorithm that comprised ART and sexual-risk assessment, risk-reduction messages, and health-promotion planning. Self-reported measures were assessed before, immediately after, and 2 months post-training. Consistent ART adherence assessment was reported by 29% of nurses at baseline and 66% at 2 months post-training (p < .001). Assessment of patient sexual behaviors was 25% at baseline and 60% at 2 months post-training (p < .001). Nurse practice behaviors recommended in the counseling algorithm improved significantly at 2 months post-training compared with baseline, odds ratios 4.30-10.50. We found that training nurses in clinical counseling for ART adherence and positive prevention is feasible. Future studies should test impact of nurse counseling on patient outcomes in resource-limited settings.
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Affiliation(s)
- Ann E Kurth
- University of Washington, Seattle, Washington, USA
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Rose CD, Koester KA, Kang Dufour MS, Myers JJ, Shade SB, McCready K, Morin S. Messages HIV clinicians use in prevention with positives interventions. AIDS Care 2012; 24:704-11. [PMID: 22299672 DOI: 10.1080/09540121.2011.644232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Prevention with Positives (PwP) is a component of the US HIV prevention strategy that targets HIV-infected persons who are aware of their seropositive status. This paper examines the use of prevention messages by clinical providers during the PwP intervention period of the US Health Resources and Services Administration's Special Projects of National Significance program. Quantitative approaches were used to learn which prevention topics were most discussed and qualitative interviews were also utilized to better understand the clinician perspective in providing prevention counseling. At 12-month follow-up, there was a significant increase in the percent of patients receiving all PwP counseling messages (p<0.01). Providers reported discussing safer sex with 91% of patients when sexually transmitted infection (STI) screening was conducted during a visit, an increase from baseline (83.5%). The percent of providers reporting they regularly explained the risk of superinfection to their clients also increased from 75% at baseline to 90% at 12-month follow up (p<0.001). Qualitative data suggest that providers prioritize individual care over public health approaches to PwP in counseling. Discussing superinfection offered providers a way to discuss HIV prevention from a non-judgmental clinical perspective while focusing on a patient-centered philosophy of care. However, the threat of superinfection may not be the best counseling option. Examples such as STI screening, giving messages to reduce the number of sexual partners and adherence to medication, are more evidence-based approaches to changing HIV transmission risk behavior and may be more important in PwP. Findings suggest that in order for HIV care providers to incorporate HIV prevention discussions into their practice, acceptable approaches to speaking about risk behavior and prevention of HIV transmission must be developed.
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Affiliation(s)
- Carol Dawson Rose
- Center for AIDS Prevention Studies, University of California, San Francisco, 94105, USA.
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HIV intervention for providers study: a randomized controlled trial of a clinician-delivered HIV risk-reduction intervention for HIV-positive people. J Acquir Immune Defic Syndr 2011; 55:572-81. [PMID: 20827218 DOI: 10.1097/qai.0b013e3181ee4c62] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clinician-delivered prevention interventions offer an opportunity to integrate risk-reduction counseling as a routine part of medical care. The HIV Intervention for Providers study, a randomized controlled trial, developed and tested a medical provider HIV prevention training intervention in 4 northern California HIV care clinics. Providers were assigned to either the intervention or control condition (usual care). The intervention arm received a 4-hour training on assessing sexual risk behavior with HIV-positive patients and delivering risk-reduction-oriented prevention messages to patients who reported risk behaviors with HIV-uninfected or unknown-status partners. To compare the efficacy of the intervention versus control on transmission risk behavior, 386 patients of the randomized providers were enrolled. Over six-months of follow-up, patients whose providers were assigned the intervention reported a relative increase in provider-patient discussions of safer sex (OR = 1.49; 95% CI = 1.06 to 2.09), assessment of sexual activity (OR = 1.60; 95% CI = 1.05 to 2.45), and a significant decrease in the number of sexual partners (OR = 0.49, 95% CI = 0.26 to 0.92). These findings show that a brief intervention to train HIV providers to identify risk and provide a prevention message results in increased prevention conversations and significantly reduced the mean number of sexual partners reported by HIV-positive patients.
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Sikkema KJ, Hansen NB, Kochman A, Santos J, Watt MH, Wilson PA, Delorenzo A, Laudato J, Mayer G. THE DEVELOPMENT AND FEASIBILITY OF A BRIEF RISK REDUCTION INTERVENTION FOR NEWLY HIV-DIAGNOSED MEN WHO HAVE SEX WITH MEN. JOURNAL OF COMMUNITY PSYCHOLOGY 2011; 39:717-732. [PMID: 22228917 PMCID: PMC3249751 DOI: 10.1002/jcop.20463] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Men who have sex with men (MSM) represent more than half of all new HIV infections in the United States. Utilizing a collaborative, community based approach, a brief risk reduction intervention was developed and pilot tested among newly HIV-diagnosed MSM receiving HIV care in a primary care setting. Sixty-five men, within 3 months of diagnosis, were randomly assigned to the experimental condition or control condition and assessed at baseline, 3-month, and 6-month follow-up. Effect sizes were calculated to explore differences between conditions and over time. Results demonstrated the potential effectiveness of the intervention in reducing risk behavior, improving mental health, and increasing use of ancillary services. Process evaluation data demonstrated the acceptability of the intervention to patients, clinic staff, and administration. The results provide evidence that a brief intervention can be successfully integrated into HIV care services for newly diagnosed MSM and should be evaluated for efficacy.
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Strauss SM, Munoz-Plaza CE, Tiburcio NJ, Gwadz M. Barriers and facilitators in implementing "prevention for positives" alcohol-reduction support: the perspectives of directors and providers in hospital-based HIV care centers. J Assoc Nurses AIDS Care 2011; 23:30-40. [PMID: 21570321 DOI: 10.1016/j.jana.2011.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
Abstract
HIV-infected patients have considerable need for alcohol reduction support, and HIV care providers are strategically placed to implement a "prevention for positives" alcohol-reduction approach through alcohol screening and brief interventions (SBIs). To facilitate this approach, we provided alcohol SBI education and training to HIV care providers in four hospital-based, New York City HIV Care Centers in 2007. Interviews with the medical directors and 14 of the HIV care providers who attended the training identified barriers to implementing alcohol SBIs. These included limited time for alcohol screening, patients' incomplete disclosure of alcohol use, providers' perceptions that alcohol use is not a major problem for their patients, and provider specialization that assigns patients with problematic alcohol use to specifically designated providers. Identified facilitators for alcohol SBI implementation included adequate time to conduct the SBI; availability of information, tools, and key points to emphasize with HIV-infected patients; and use of a brief alcohol screening tool.
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Laws MB, Bradshaw YS, Safren SA, Beach MC, Lee Y, Rogers W, Wilson IB. Discussion of sexual risk behavior in HIV care is infrequent and appears ineffectual: a mixed methods study. AIDS Behav 2011; 15:812-22. [PMID: 20981480 DOI: 10.1007/s10461-010-9844-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Consensus guidelines in HIV care call for clinicians to provide a brief sexual risk behavioral intervention in each visit. Studies based on participant reports find this occurs infrequently, but studies based on direct observation of clinical encounters are lacking. We conducted a mixed method study that used audio recordings of 116 routine outpatient visits by 58 different patients with HIV, in five different practice sites. Transcripts of the visits were coded and analyzed using a quantitative system. In addition, we conducted a qualitative analysis of the dialogue segments in which sexual risk behaviors arose as a topic. Discussion of sexual risk behavior occurred in 10 visits, and was generally quite brief. Two visits featured substantial counseling about sexual risk reduction; two others included substantial discussion which was not evidently directed at the patient's changing behavior. Cues suggesting a need or opportunity for such discussion that physicians did not follow up on occurred in seven additional visits. Interactions about sexual risk had less patient engagement than interactions about other health behaviors. Physicians seldom provide sexual risk reduction counseling in HIV care, even where specific indications are present.
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Affiliation(s)
- M Barton Laws
- Public Health Program, Warren Alpert School of Medicine, Brown University, G-S121-7, Providence, RI 02912, USA.
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Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005-2009: Do patients who initiate care stay in care? AIDS Patient Care STDS 2011; 25:79-88. [PMID: 21284498 DOI: 10.1089/apc.2010.0151] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this era of effective antiretroviral therapy, early diagnosis of HIV and timely linkage to and retention in care are vital to survival and quality of life. Federal guidelines recommend regular monitoring of HIV-related laboratory parameters and initiation of antiretroviral treatment at specified thresholds. We used routinely reported laboratory data to measure intervals between visits by New York City residents newly diagnosed with HIV July 1 to September 30, 2005, and initiating care within 3 months of diagnosis. We measured regular care (≥1 visit every 6 months) and retention in care (last visit ≤6 months before close of analysis) through June 30, 2009. Patients were followed for 45-48 months. Seventy-seven percent (650/842) of patients initiated care within 3 months of diagnosis; 609 (93.7%) made at least one subsequent visit; 45.4% had regular care. Risk factors for not receiving regular care included age 13-24 versus 50+ (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.5, 6.0), black race (AOR 2.0, 95% CI 1.4,2.8), eligibility for antiretroviral treatment (AOR 1.5, 95% CI 1.1, 2.2), and injection drug use (IDU; AOR = 2.7. 95% CI 1.0, 7.1). In a time-to-event analysis, risk factors for loss to care were age 13-24 versus 50+ at diagnosis (adjusted hazard ratio [AHR] 1.9, 95% CI 1.1, 3.4), non-hospital site of care (AHR 1.4, 95% CI 1.0, 2.0) and early stage (non-AIDS) disease (AHR 1.4, 95% CI 1.0, 2.0). The analysis demonstrates how mandated reporting of HIV-related laboratory tests provides surveillance systems with the capacity to monitor utilization of care, identify deficits, and evaluate progress in programs designed to facilitate retention in care.
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Affiliation(s)
- Lucia V. Torian
- The New York City Department of Health and Mental Hygiene, New York, New York
| | - Ellen W. Wiewel
- The New York City Department of Health and Mental Hygiene, New York, New York
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Duffus WA, Ogbuanu IU. Prevention counseling for HIV-infected persons: what every clinician needs to know. Curr Infect Dis Rep 2010; 11:319-26. [PMID: 19545502 DOI: 10.1007/s11908-009-0047-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The absence of adequate and regular prevention counseling during routine clinical encounters translates into missed opportunities for HIV prevention. HIV care providers have considerably more contact with patients than clinicians in other disciplines. These contacts should be translated into opportunities to provide HIV prevention messages to patients and should be a priority for all clinicians caring for HIV-positive patients. Coincidental preventive care for HIV-positive patients is inherently unproductive because of the absence of reinforcing messages. In a recent meta-analysis, HIV-positive individuals who underwent counseling and testing services reduced high-risk behaviors by about 68%. Prevention counseling should focus on positive reinforcement, harm reduction, education, and support. We strongly recommend regular, brief, targeted prevention counseling as a part of every clinical encounter.
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Affiliation(s)
- Wayne A Duffus
- South Carolina Department of Health and Environmental Control, HIV/STD Division, 1751 Calhoun Street, Columbia, SC 29201, USA.
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Hall CS, Marrazzo JD. Emerging issues in management of sexually transmitted diseases in HIV infection. Curr Infect Dis Rep 2010; 9:518-30. [PMID: 17999888 DOI: 10.1007/s11908-007-0077-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Sexually transmitted diseases (STDs) occur often among sexually active persons with HIV infection. Incident STDs may complicate the course of HIV infection and potentiate HIV transmission in the coinfected individual by mucosal disruption and an increase in HIV concentration in ulcers and involved mucous membranes. Conducting ongoing periodic sexual risk assessments in HIV-positive patients in routine medical care is critical to identifying asymptomatic infections. HIV clinicians should be familiar with updated recommendations for screening, diagnosis, and treatment of bacterial and viral STDs, including those specific to HIV infection. This article addresses emerging issues in the management of STDs in HIV-infected persons and summarizes the latest evidence that can be applied to clinical decision-making in this population.
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Affiliation(s)
- Christopher S Hall
- Division of Allergy & Infectious Diseases, University of Washington, Harborview Medical Center, Center for AIDS and STD, 325 Ninth Avenue, Mailbox #359931, Seattle, WA 98104-2499, USA
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Bennett M, Strachan E, Uldall K. Development and initial validation of a brief screener for focused HIV prevention efforts. HIV Med 2010; 11:318-25. [DOI: 10.1111/j.1468-1293.2009.00774.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Malebranche DJ, Arriola KJ, Jenkins TR, Dauria E, Patel SN. Exploring the "bisexual bridge": a qualitative study of risk behavior and disclosure of same-sex behavior among black bisexual men. Am J Public Health 2010; 100:159-64. [PMID: 19910348 DOI: 10.2105/ajph.2008.158725] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored factors influencing sexual behavior, disclosure of same-sex behavior, and condom-use practices among Black bisexual men. METHODS We conducted semistructured interviews with 38 Black men in Atlanta, Georgia, who reported having had oral, vaginal, or anal sex with both men and women in the prior 6 months. RESULTS Participants described approaches to disclosure of same-sex behavior as part of a complex decisional balance influenced by both situational and individual factors and ranging from full disclosure to total secrecy. Influences on sexual behavior and condom-use practices included: (1) type of relationship, (2) gender-specific considerations, (3) perceptions of comfort or trust, and (4) fear of disease or pregnancy. CONCLUSIONS Disclosure of same-sex behavior was not a major influence on the sexual behavior and condom-use practices of the Black bisexual men in our study, who demonstrated heterogeneity in approaches to sexual behavior, disclosure of same-sex behavior, and condom-use practices. Additional research is needed to assess the social determinants of sexual risk for this population. Future HIV-prevention efforts should include initiatives to encourage accuracy in risk assessment and in taking sexual histories in clinical settings.
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Affiliation(s)
- David J Malebranche
- Emory University School of Medicine, Division of General Medicine, 49 Jesse Hill Jr. Drive, Suite 413, Atlanta, GA 30303, USA.
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Strauss SM, Harris G, Katigbak C, Rindskopf DM, Singh S, Greenblum I, Brown LS, Kipnis S, Kritz SA, Parrino MW. Alcohol education provided to opioid treatment program patients: results of a nationwide survey. JOURNAL OF DRUG EDUCATION 2010; 40:379-393. [PMID: 21381464 DOI: 10.2190/de.40.4.d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Alcohol-related problems are especially common among opioid treatment program (OTP) patients, suggesting that educating OTP patients about alcohol and its harmful effects needs to be a priority in OTPs. Using data collected in interviews with a nationwide U.S. sample of OTP directors (N = 200) in 25 states, we identified factors that differentiate OTPs that provided this education to all OTP patients from those that did not. Findings indicate that these factors include (1) providing this education in a greater variety of ways, (2) having a larger percent of staff knowledgeable about alcohol-related issues, (3) having a director who views alcohol issues as a high priority, and (4) having a written OTP policy.
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Affiliation(s)
- Shiela M Strauss
- New York University College of Nursing, New York, NY 10003, USA.
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33
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Pereyra M, Metsch LR, Gooden L. HIV-positive patients' discussion of oral health with their HIV primary care providers in Miami, Florida. AIDS Care 2009; 21:1578-84. [PMID: 20024737 DOI: 10.1080/09540120902923030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Over 90% of HIV-positive persons will have at least one oral manifestation of HIV disease during the course of infection. Clinical guidelines suggest that examination of the oral cavity should be included in initial and interim physical examinations of all HIV-infected patients by their HIV care providers. Clinically significant manifestations of oral disease may impact prescribed treatment regimens. The objective of this analysis was to describe HIV-positive patients' discussion of oral health and dental health with their HIV primary care providers and the correlates of this discussion. We used cross-sectional data from the baseline of a randomized trial testing the efficacy of a risk reduction intervention. Participants were HIV-positive male and female patients attending five HIV primary care clinics in Miami-Dade County, Florida, USA. Overall, 37% of patients did not discuss oral health with their provider. After controlling for age, gender, education, and clinic, odds of discussion of oral health for respondents with five or more primary care visits in the past year were half the odds of those with fewer visits (odds ratio (OR)=0.525, 95% confidence interval (CI): 0.336, 0.821). Odds of discussion for men reporting illicit drug use were 35% of that for non-drug using men (OR=0.353, 95% CI: 0.186, 0.671). Odds of discussion were 1.4 times greater for each additional health topic discussed (e.g., nutrition and smoking) (95% CI: 1.317, 1.544). Given that more than one-third of patients reported no discussion of oral health with HIV primary care providers in the past year, there is a need to increase the focus on oral health in the HIV primary care setting.
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Affiliation(s)
- Margaret Pereyra
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Gilliam PP, Straub DM. Prevention with positives: a review of published research, 1998-2008. J Assoc Nurses AIDS Care 2009; 20:92-109. [PMID: 19286122 DOI: 10.1016/j.jana.2008.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
Abstract
HIV prevention education and counseling efforts have historically been directed toward those individuals considered at risk for exposure to HIV and assumed to be uninfected with HIV. In the late 1990s, prevention efforts began to include individuals who were HIV-infected. In 2003, the Centers for Disease Control and Prevention recommended that HIV prevention be incorporated into the medical care of persons living with HIV. This domain of HIV prevention work is known as prevention with positives or positive prevention, and research within this domain has been ongoing for a decade. This article provides a review of the scientific evidence within the prevention with positives domain from 1998 to 2008. A discussion is provided regarding early descriptive and formative studies as well as more recent and ongoing intervention trials specifically designed for persons living with HIV. A summary of current knowledge, a description of ongoing research, and gaps in knowledge are identified. Topics for future research are suggested.
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Relf MV, Bishop TL, Lachat MF, Schiavone DB, Pawlowski L, Bialko MF, Boozer DL, Dekker D. A qualitative analysis of partner selection, HIV serostatus disclosure, and sexual behaviors among HIV-positive urban men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2009; 21:280-297. [PMID: 19519241 DOI: 10.1521/aeap.2009.21.3.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Using grounded theory, 18 interviews with HIV-positive urban men were conducted to understand their sexual relationships. Analysis of the verbatim transcripts revealed that regardless of age, sexual orientation or race/ethnicity, the participants were "making choices" related to their sexual relationships. Some men were "avoiding sex" whereas others were engaging in "just sex" or having sex in a relationship that was "going somewhere." However, dependent upon the type of sexual relationship, these HIV-positive urban men struggled with issues associated with "disclosure" of serostatus, the sexual "behaviors" in which they engaged, and selecting sexual "partners." Health care providers can facilitate sexual health and well-being among HIV-positive urban men by recognizing that men may be seeking sexual intimacy for different purposes, in different types of relationships, or avoiding it entirely. By exploring these decision-making processes, it is possible to facilitate sexual relationships that prevent new infections as well as manage the dissonance associated with this decision-making associated with disclosure, behaviors and their sexual partners.
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Affiliation(s)
- Michael V Relf
- School of Nursing, Duke University, Durham, NC 27710, USA.
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36
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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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A behavioral intervention reduces HIV transmission risk by promoting sustained serosorting practices among HIV-infected men who have sex with men. J Acquir Immune Defic Syndr 2009; 49:544-51. [PMID: 18989221 DOI: 10.1097/qai.0b013e31818d5def] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine factors that explain the effect of a cognitive-behavioral intervention on reductions in HIV transmission risk among HIV-infected men who have sex with men (MSM). METHOD Of the 1910 HIV-infected MSM screened, 616 participants considered to be at risk of transmitting HIV were randomized to a 15-session, individually delivered cognitive-behavioral intervention (n=301) or a wait-list control (n=315). RESULTS Consistent with previous intent-to-treat findings, there was an overall reduction in transmission risk acts among MSM in both intervention and control arms, with significant intervention effects observed at the 5-, 10-, 15-, and 20-month assessments (risk ratios=0.78, 0.62, 0.48, and 0.38, respectively). These intervention-related decreases in HIV transmission risk acts seemed to be partially due to sustained serosorting practices. MSM in the intervention condition reported a significantly greater proportion of sexual partners who were HIV infected at the 5- and 10-month assessments (risk ratios=1.14 and 1.18). CONCLUSIONS The Healthy Living Project, a cognitive-behavioral intervention, is efficacious in reducing transmission risk acts among MSM. This seems to have been due in large part to the fact that MSM in the intervention condition reported sustained serosorting practices.
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38
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Strauss SM, Tiburcio NJ, Munoz-Plaza C, Gwadz M, Lunievicz J, Osborne A, Padilla D, McCarty-Arias M, Norman R. HIV care providers' implementation of routine alcohol reduction support for their patients. AIDS Patient Care STDS 2009; 23:211-8. [PMID: 19866539 DOI: 10.1089/apc.2008.0008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Screening and brief intervention (SBI) for alcohol reduction is an important health promoting strategy for patients with HIV, and HIV care providers are optimally situated to support their patients' reduction efforts. We report results from analyses that use data collected from providers (n = 115) in 7 hospital-based HIV care centers in the New York City metropolitan area in 2007 concerning their routine use of 11 alcohol SBI components with their patients. Providers routinely implemented 5 or more of these alcohol SBI components if they (1) had a specific caseload (and were therefore responsible for a smaller number of patients), (2) had greater exposure to information about alcohol's effect on HIV, (3) had been in their present positions for at least 1 year, and (4) had greater self efficacy to support patients' alcohol reduction efforts. Findings suggest the importance of educating all HIV care providers about both the negative impact of excessive alcohol use on patients with HIV and the importance and value of alcohol SBIs. Findings also suggest the value of promoting increased self efficacy for at least some providers in implementing alcohol SBI components, especially through targeted alcohol SBI training.
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Affiliation(s)
| | | | | | - Marya Gwadz
- National Development and Research Institutes, Inc., New York, New York
| | - Joseph Lunievicz
- National Development and Research Institutes, Inc., New York, New York
| | - Andrew Osborne
- National Development and Research Institutes, Inc., New York, New York
| | - Diana Padilla
- National Development and Research Institutes, Inc., New York, New York
| | | | - Robert Norman
- College of Dentistry New York University, New York, New York
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Illa L, Brickman A, Saint-Jean G, Echenique M, Metsch L, Eisdorfer C, Bustamante-Avellaneda V, Sanchez-Martinez M. Sexual risk behaviors in late middle age and older HIV seropositive adults. AIDS Behav 2008; 12:935-42. [PMID: 18404364 DOI: 10.1007/s10461-008-9370-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 02/21/2008] [Indexed: 10/22/2022]
Abstract
Little is known about the sexual behaviors of older adults, although the prevalence of HIV/AIDS is rapidly increasing in this population. As part of a larger multi-site study examining secondary HIV prevention, we recruited from an HIV primary care clinic 210 sexually active HIV positive individuals aged 45 and over (125 men, 85 women) who had engaged in vaginal or anal sex within the past six months. Twenty percent of the participants reported inconsistent use of condoms and 33% had multiple sexual partners during the previous six months. Negative mood and perceived HIV stigma were associated with inconsistent condom use. In addition, multiple sex partners and higher level of education were related to inconsistent condom use during sex with partners of negative or unknown serostatus. These findings indicate that contrary to current beliefs, sexually active older adults, similar to younger ones, may be engaging in high risk transmission behaviors.
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Affiliation(s)
- Lourdes Illa
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Ave, Miami, FL 33131, USA.
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40
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Iverson EF, Balasuriya D, García GP, Sheng M, Richardson JL, Stoyanoff S, King JB. The challenges of assessing fidelity to physician-driven HIV prevention interventions: lessons learned implementing Partnership for Health in a Los Angeles HIV clinic. AIDS Behav 2008; 12:978-88. [PMID: 18427973 DOI: 10.1007/s10461-008-9392-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 03/25/2008] [Indexed: 01/16/2023]
Abstract
Documenting fidelity to HIV prevention interventions is critical to ensure consistency in intervention implementation and necessary for measuring intervention exposure and, ultimately, outcomes. Significant variation from prescribed protocols or inconsistent implementation can jeopardize the integrity of evaluation research and render outcomes uninterpretable. There is increasing support for HIV prevention models targeting seropositive individuals designed to be delivered by physicians during clinic visits. Assessing fidelity to physician-delivered interventions that occur during clinical exams present unique challenges. This paper presents findings from various data sources designed to track intervention fidelity and exposure to the Partnership for Health intervention, a physician-delivered HIV prevention intervention implemented in an urban community HIV clinic. We present findings from chart abstraction data, patient surveys and exit interviews, and provider qualitative interviews. Lessons learned and recommendations for maximizing the accuracy and validity of fidelity assessment in future evaluations of HIV prevention interventions in primary care settings are considered.
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41
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Metsch LR, Pereyra M, Messinger S, Del Rio C, Strathdee SA, Anderson-Mahoney P, Rudy E, Marks G, Gardner L. HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care. Clin Infect Dis 2008; 47:577-84. [PMID: 18624629 DOI: 10.1086/590153] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We examined the relationship between receipt of medical care for human immunodeficiency virus (HIV) infection and HIV transmission risk behavior among persons who had received a recent diagnosis of HIV infection. METHODS We enrolled 316 participants from 4 US cities and prospectively followed up participants for 1 year. Generalized estimating equations were used to examine whether having at least 3 medical care visits in a 6-month period was associated with unprotected vaginal or anal intercourse with an HIV-negative partner or partner with unknown HIV status. RESULTS A total of 27.5% of the participants (84 of 305) self-reported having unprotected sex with an HIV-negative or unknown status partner at enrollment, decreasing to 12% (31 of 258) and 14.2% (36 of 254) at 6-month and 12-month follow-ups, respectively. At follow-up, people who had received medical care for HIV infection at least 3 times had reduced odds of engaging in risk behavior, compared with those with fewer visits. Other factors associated with reduced risk behavior were being >30 years of age, male sex, not having depressive symptoms, and not using crack cocaine. CONCLUSIONS Being in HIV care is associated with a reduced prevalence of sexual risk behavior among persons living with HIV infection. Persons linked to care can benefit from prevention services available in primary care settings.
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Affiliation(s)
- Lisa R Metsch
- Miller School of Medicine, University of Miami, Miami, Florida, USA
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42
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Remien RH, Berkman A, Myer L, Bastos FI, Kagee A, El-Sadr WM. Integrating HIV care and HIV prevention: legal, policy and programmatic recommendations. AIDS 2008; 22 Suppl 2:S57-65. [PMID: 18641470 PMCID: PMC2788755 DOI: 10.1097/01.aids.0000327437.13291.86] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Since the start of the HIV epidemic we have witnessed significant advances in our understanding of the impact of HIV disease worldwide. Furthermore, breakthroughs in treatment and the rapid expansion of HIV care and treatment programmes in heavily impacted countries over the past 5 years are potentially critical assets in a comprehensive approach to controlling the continued spread of HIV globally. A strategic approach to controlling the epidemic requires continued and comparable expansion and integration of care, treatment and prevention programmes. As every new infection involves transmission, whether vertically or horizontally, from a person living with HIV/AIDS (PLWHA), the integration of HIV prevention into HIV care settings has the potential to prevent thousands of new infections, as well as to improve the lives of PLWHA. In this paper, we highlight how to better utilize opportunities created by the antiretroviral roll-out to achieve more effective prevention, particularly in sub-Saharan Africa. We offer specific recommendations for action in the domains of healthcare policy and practice in order better to utilize the advances in HIV treatment to advance HIV prevention.
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Affiliation(s)
- Robert H Remien
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, USA.
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Steward WT, Charlebois ED, Johnson MO, Remien RH, Goldstein RB, Wong FL, Morin SF. Receipt of Prevention Services Among HIV-Infected Men Who Have Sex with Men. Am J Public Health 2008; 98:1011-4. [DOI: 10.2105/ajph.2007.124933] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grodensky CA, Golin CE, Boland MS, Patel SN, Quinlivan EB, Price M. Translating concern into action: HIV care providers' views on counseling patients about HIV prevention in the clinical setting. AIDS Behav 2008; 12:404-11. [PMID: 17577658 DOI: 10.1007/s10461-007-9225-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 03/14/2007] [Indexed: 11/30/2022]
Abstract
Recent Centers for Disease Control (CDC) guidelines recommend that HIV care practitioners provide HIV prevention counseling to patients at routine medical visits. However, research shows that HIV care practitioners provide such counseling infrequently, presenting a challenge for clinics implementing these guidelines. Our qualitative study of 19 HIV care providers at an infectious diseases clinic in the southeastern US explored providers' beliefs about their patients' HIV transmission behaviors, expected outcomes of conducting HIV prevention counseling, and perceived barriers and facilitators to counseling. Providers' concern about HIV transmission among their patients was high but did not "translate into action" in the form of counseling. They anticipated poor outcomes from counseling, including harm to patient-provider relationships, and failure of patients to change their behavior. They also listed barriers and facilitators to counseling, most importantly time, state reporting policies, and conversational triggers. Implications for implementation of CDC guidelines and clinic-based "Prevention with Positives" programs are discussed.
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Affiliation(s)
- Catherine A Grodensky
- Department of Health Behavior and Health Education, School of Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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45
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Gilbert P, Ciccarone D, Gansky SA, Bangsberg DR, Clanon K, McPhee SJ, Calderón SH, Bogetz A, Gerbert B. Interactive "Video Doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings. PLoS One 2008; 3:e1988. [PMID: 18431475 PMCID: PMC2292251 DOI: 10.1371/journal.pone.0001988] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 03/01/2008] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide "prevention with positives" in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors. METHODOLOGY AND FINDINGS We conducted a parallel groups randomized controlled trial (December 2003-September 2006) at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults) completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476) were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a "Video Doctor" via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months) and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months). Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months) than did controls, and had fewer casual sex partners at (-2.3 vs. -1.4, p = 0.461, at 3 months; and -2.7 vs. -0.6, p = 0.042, at 6 months). CONCLUSIONS The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level, and modest individual-level reductions in days of ongoing drug use and number of casual sex partners compared with the control group. Positive Choice, including Video Doctor counseling, is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient settings, and holds promise as a public health HIV intervention. TRIAL REGISTRATION Clinicaltrials.gov NCT00447707.
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Affiliation(s)
- Paul Gilbert
- Division of Behavioral Sciences, Professionalism, and Ethics, University of California San Francisco, San Francisco, California, United States of America
| | - Daniel Ciccarone
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Stuart A. Gansky
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, California, United States of America
| | - David R. Bangsberg
- Epidemiology and Prevention Interventions (EPI) Center, Division of Infectious Diseases and Positive Health Program, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Kathleen Clanon
- East Bay AIDS Education and Training Center, Oakland, California, United States of America
| | - Stephen J. McPhee
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sophia H. Calderón
- Division of Behavioral Sciences, Professionalism, and Ethics, University of California San Francisco, San Francisco, California, United States of America
| | - Alyssa Bogetz
- Division of Behavioral Sciences, Professionalism, and Ethics, University of California San Francisco, San Francisco, California, United States of America
| | - Barbara Gerbert
- Division of Behavioral Sciences, Professionalism, and Ethics, University of California San Francisco, San Francisco, California, United States of America
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Schackman BR, Dastur Z, Ni Q, Callahan MA, Berger J, Rubin DS. Sexually active HIV-positive patients frequently report never using condoms in audio computer-assisted self-interviews conducted at routine clinical visits. AIDS Patient Care STDS 2008; 22:123-9. [PMID: 18260803 DOI: 10.1089/apc.2007.0037] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV prevention has become a new priority for HIV clinicians, as their patients live longer and more sexually active lives. Prevention interventions can be effective in clinical settings, but first patients must be screened and inconsistent condom use must be disclosed. Audio computer-assisted self-interviews (ACASI) are an effective way to elicit this sensitive information. We assessed condom use by ACASI among 198 English- or Spanish-speaking HIV patients at 2 community hospital-based HIV clinics in Queens and the Bronx, New York. Among 120 patients reporting sex with a regular partner in the past 4 weeks, 41 (34%) reported not using a condom every time and 22 (18%) reported never using a condom. Among 81 reporting sex with a casual partner in the past 4 weeks, 21 (26%) reported not using a condom every time and 12 (15%) reported never using a condom. Overall, 24 of 129 sexually active patients (19%) reported never using a condom. In a multivariable model controlling for age, race/ethnicity, gender, and HIV exposure category, depression symptoms (Center for Epidemiological Studies Depression Scale [CES-D] score >/= 16; p = 0.03) and self-reported antiretroviral medication non-adherence (</=95% doses in past 3 days; p = 0.03) were significantly associated with never using a condom with a regular or casual partner. ACASI interviews may be an effective way of identifying patients in clinical settings who require prevention counseling as well as other psychosocial services.
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Affiliation(s)
- Bruce R. Schackman
- Department of Public Health, Weill Cornell Medical College, New York, New York
| | - Zubin Dastur
- Department of Public Health, Weill Cornell Medical College, New York, New York
| | - Quanhong Ni
- Department of Public Health, Weill Cornell Medical College, New York, New York
| | - Mark A. Callahan
- Department of Public Health, Weill Cornell Medical College, New York, New York
| | | | - David S. Rubin
- New York Hospital Medical Center of Queens, Flushing, New York
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Morin SF, Myers JJ, Shade SB, Koester K, Maiorana A, Rose CD. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav 2007; 11:S6-16. [PMID: 17577655 DOI: 10.1007/s10461-007-9253-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 04/30/2007] [Indexed: 10/23/2022]
Abstract
We assessed risk of transmission among 4,016 HIV-infected patients in primary care, including men who have sex with men (MSM, n = 2,109), women (n = 1,104) and men who had sex with women (MSW, n = 803) in clinics in 15 cities across the U.S. A transmission risk act, assessed by computer assisted interviews, was defined as unprotected vaginal or anal sex with a partner who was HIV-uninfected or of unknown HIV status. MSM were more than twice as likely to report transmission risk acts than MSW (Odds Ratio [OR] = 2.35; 95% Confidence Interval [CI] = 1.84, 3.00; P < or = .001). Women were also more likely to report transmission risk acts than MSW (OR = 1.56; 95% CI = 1.19, 2.05; P < or = .001). Stimulant use was associated with transmission risk in all three groups (P < or = .05). MSM were more likely to use methamphetamines (8% versus 2% and 3% respectively), while MSW (17%) and women (12%, compared to 11% for MSM) were more likely to use cocaine. Clinical settings offer opportunities for preventing HIV transmission, particularly if interventions are tailored to sub-populations of HIV-infected patients.
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Affiliation(s)
- Stephen F Morin
- Center for AIDS Prevention Studies, University of California, San Francisco, 50 Beale St., Suite 1300, San Francisco, CA 94105, USA.
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Remien RH, Exner TM, Morin SF, Ehrhardt AA, Johnson MO, Correale J, Marhefka S, Kirshenbaum SB, Weinhardt LS, Rotheram-Borus MJ, Catz SL, Gore-Felton C, Chesney MA, Kelly J. Medication adherence and sexual risk behavior among HIV-infected adults: implications for transmission of resistant virus. AIDS Behav 2007; 11:663-75. [PMID: 17243012 DOI: 10.1007/s10461-006-9201-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 12/05/2006] [Indexed: 11/25/2022]
Abstract
As more people are living long-term with HIV there are growing concerns about specific behaviors that can affect both personal and the public health. This study examined the relationship between antiretroviral therapy (ART) adherence and sexual risk behavior and their association with psychosocial and health factors among a diverse sample of 2,849 HIV-infected adults. Only 8.5% of the sample reported both non-adherence and sexual risk. Individuals were 46% more likely to report one of these risk outcomes when the other one was present and the presence of both outcomes was associated with an increased likelihood of having a detectable viral load. A simultaneous polytomous regression analysis revealed complex relationships among a range of psychosocial variables and the two primary behavioral risk outcomes. There is a need for targeted interventions and integration of mental health and substance use services into primary HIV care settings.
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Affiliation(s)
- Robert H Remien
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
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49
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Malitz FE, Eldred L. Evolution of the special projects of national significance prevention with HIV-infected persons seen in primary care settings initiative. AIDS Behav 2007; 11:S1-5. [PMID: 17546495 DOI: 10.1007/s10461-007-9252-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 04/30/2007] [Indexed: 10/23/2022]
Affiliation(s)
- Faye E Malitz
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, USA.
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50
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Raja S, McKirnan D, Glick N. The Treatment Advocacy Program--Sinai: a peer-based HIV prevention intervention for working with African American HIV-infected persons. AIDS Behav 2007; 11:S127-37. [PMID: 17436076 DOI: 10.1007/s10461-007-9226-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
As HIV/AIDS continues to disproportionately affect African American communities, there is a growing need for empirically based, culturally appropriate, tailored interventions for this clientele. As part of a Health Resources and Services Administration (HRSA)/Special Projects of National Significance (SPNS) initiative to increase prevention amongst those living with HIV, we implemented the Treatment Advocacy Program Intervention at Mount Sinai Hospital in Chicago, IL, USA. The main goal of the intervention was to help patients increase their medication adherence and sexual safety skills. This paper describes the rationale for implementing this peer-based HIV-prevention intervention, discusses how the intervention was tailored to work within our low socio-economic status, urban patient population, and reviews the training and quality assurance activities needed to integrate the intervention into our primary care clinic. We review the intervention content in detail, including the structure of the multiple, one-on-one education sessions, and the core topics covered (medication adherence and sexual safety). Finally, we discuss the challenges in implementing this program, many of which arise from the chaotic social situations that our patients experience.
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Affiliation(s)
- Sheela Raja
- Mount Sinai Hospital Medical Center, Urban Health Institute, California Avenue at 15th Street, Chicago, IL 60608, USA.
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