Marseille 2007
Marseille 2007
Abstract book
Go Back

Abstract #413  -  Counselor-delivered risk reduction intervention reduces unprotected sex among HIV-infected patients in clinical care in urban KwaZulu-Natal, South Africa
Session:
  38.1: Counselling and Therapy (Parallel) on Tuesday @ 14.00-16.00 in CP Chaired by Barbara Hedge, Michael Blank
Authors:
  Presenting Author:   Dr Deborah Cornman - University of Connecticut, United States
 
  Additional Authors:  Ms Sarah  Christie, Dr Susan Kiene, Dr Jeffrey  Fisher, Dr William Fisher, Dr Paul Shuper, Dr Sandy Pillay, Dr Gerald Friedland,  
Aim:
South Africa is currently experiencing one of the most severe HIV epidemics in the world, but there is growing hope that the ARV rollout underway will help to abate the epidemic by providing increased access to effective treatment. The ARV rollout presents a unique opportunity to address PLWHAs risk reduction needs by linking HIV prevention interventions with HIV clinical care. The primary objective of this study was to explore the feasibility, fidelity, and effectiveness of a theory-based intervention that is delivered by counselors in the clinical care setting and designed to reduce risky sexual behavior among South Africa PLWHA.
 
Method / Issue:
In this randomized clinical trial, 5 HIV adherence counselors were randomly assigned to intervention (3 counselors) or standard-of-care control (2 counselors) condition, and 152 HIV-positive patients (103 intervention, 49 control) were randomly assigned to a counselor. Intervention but not standard-of-care control counselors received training in the intervention. The intervention was based on the Information-Motivation-Behavioral Skills Model of HIV prevention (Fisher & Fisher, 1992, 2000, 2002) and consisted of an 8-step framework for tailoring discussions to patients specific HIV risk reduction needs. These brief patient-centered discussions occurred during routine clinical visits, and were repeated at each visit for 6 months. Outcome assessments were conducted in isi-Zulu or English at baseline and 6-month follow-up to assess demographics and sexual behavior.
 
Results / Comments:
The intervention was delivered in 99% of routine patient visits, with about 2.5 intervention visits per patient over 6 months; it was delivered with considerable fidelity and included all 8 requisite intervention steps. Exit interviews with patients indicated that counselors implemented the intervention in a supportive, helpful, non-judgmental fashion. Analysis of intervention impact on unprotected vaginal and anal sexual events revealed a significant condition x time interaction (b= -2.24, se=.92, p=.016, event rate ratio=.11 CI=.01 - .87), with a significant decrease over time in unprotected vaginal and anal sexual events among HIV-infected patients in the intervention condition (b= -1.41, se=.65, p<.05, event rate ratio=.24, CI=.07 - .89), but a marginally significant increase among those in the standard-of-care control condition (b= .67, se=.34, p=.05, event rate ratio=1.95, CI=1.00 3.83). Similarly, analysis of intervention impact on the number of unprotected sex events with perceived HIV-negative or unknown status partners revealed a marginally significant time x condition interaction (b= -2.35, se=.10, p=.06, event rate ratio=.096, CI=.008 1.11), such that the number of unprotected sex events with HIV-negative or unknown status partners decreased from baseline to follow-up for participants in the intervention condition but increased over time for participants in the control condition.
 
Discussion:
The findings from this study are among the first to demonstrate that a brief counselor-delivered HIV risk reduction intervention for PLWHA in South Africa is feasible to implement during the course of routine clinical care, can be delivered with fidelity, is acceptable to HIV+ patients, and may potentially be effective at reducing HIV+ patients unprotected vaginal and anal sexual behavior. This intervention may be a promising first step towards integrating HIV prevention and care in South Africa, and reducing HIV risk behavior among PLWHA.
 
Go Back

  Disclaimer   |   T's & C's   |   Copyright Notice    www.AIDSImpact.com www.AIDSImpact.com