Jeffrey D Fisher1, Deborah H Cornman, Paul A Shuper, Sarah Christie, Sandy Pillay, Susan Macdonald, Ntombenhle Ngcobo, K Rivet Amico, Umesh Lalloo, Gerald Friedland, William A Fisher. 1. *Department of Psychology, University of Connecticut, Storrs, CT; †Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT; ‡Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; §Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ‖Division of Research and Post-graduate Support, Durban University of Technology, Durban South Africa; ¶Enhancing Care Foundation, Durban University of Technology, Durban, South Africa; #Department of Health Behavior and Health Education, School of Public Health, University of Michigan; **AIDS Program, Section of Infectious Diseases, Departments of Medicine and Public Health, Yale School of Medicine, New Haven, CT; and ††Departments of Psychology and Obstetrics and Gynaecology, University of Western Ontario, London, Ontario, Canada.
Abstract
CONTEXT: Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression. OBJECTIVE: To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART. DESIGN:Cluster-randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard of care. SETTING: Publicly funded HIV clinical care sites. PATIENTS: One thousand eight hundred ninety-one PLWH on ART received theHIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924). INTERVENTION: Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information-Motivation-Behavioral (IMB) Skills model during routine clinical care. MAIN OUTCOME MEASURES: Number of sexual events without a condom in the past 4 weeks with partners of any HIV status, and with partners perceived to be HIV negative or HIV-status unknown, assessed at baseline, 6, 12, and 18 months. RESULTS: Intervention participants reported significantly greater reductions in HIV risk behavior on both primary outcomes, compared with standard-of-care participants. Differences in sexually transmitted infection incidence between arms were not observed. CONCLUSIONS: Effective behavioral interventions, delivered by lay counselors within the clinical care setting, are consistent with the strategy of linking HIV care and HIV prevention and integrating biomedical and behavioral approaches to stemming the HIV epidemic. TRIAL REGISTRATION: Not applicable.
RCT Entities:
CONTEXT: Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression. OBJECTIVE: To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART. DESIGN: Cluster-randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard of care. SETTING: Publicly funded HIV clinical care sites. PATIENTS: One thousand eight hundred ninety-one PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924). INTERVENTION: Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information-Motivation-Behavioral (IMB) Skills model during routine clinical care. MAIN OUTCOME MEASURES: Number of sexual events without a condom in the past 4 weeks with partners of any HIV status, and with partners perceived to be HIV negative or HIV-status unknown, assessed at baseline, 6, 12, and 18 months. RESULTS: Intervention participants reported significantly greater reductions in HIV risk behavior on both primary outcomes, compared with standard-of-care participants. Differences in sexually transmitted infection incidence between arms were not observed. CONCLUSIONS: Effective behavioral interventions, delivered by lay counselors within the clinical care setting, are consistent with the strategy of linking HIV care and HIV prevention and integrating biomedical and behavioral approaches to stemming the HIV epidemic. TRIAL REGISTRATION: Not applicable.
Authors: Quarraisha Abdool Karim; Salim S Abdool Karim; Janet A Frohlich; Anneke C Grobler; Cheryl Baxter; Leila E Mansoor; Ayesha B M Kharsany; Sengeziwe Sibeko; Koleka P Mlisana; Zaheen Omar; Tanuja N Gengiah; Silvia Maarschalk; Natasha Arulappan; Mukelisiwe Mlotshwa; Lynn Morris; Douglas Taylor Journal: Science Date: 2010-07-19 Impact factor: 47.728
Authors: Thomas P Eisele; Catherine Mathews; Mickey Chopra; Mark N Lurie; Lisanne Brown; Sarah Dewing; Carl Kendall Journal: AIDS Behav Date: 2008-10-10
Authors: Raph L Hamers; Carole L Wallis; Cissy Kityo; Margaret Siwale; Kishor Mandaliya; Francesca Conradie; Mariette E Botes; Maureen Wellington; Akin Osibogun; Kim C E Sigaloff; Immaculate Nankya; Rob Schuurman; Ferdinand W Wit; Wendy S Stevens; Michèle van Vugt; Tobias F Rinke de Wit Journal: Lancet Infect Dis Date: 2011-07-27 Impact factor: 25.071
Authors: Sarah A Gutin; K Rivet Amico; Elsa Hunguana; António Orlando Munguambe; Carol Dawson Rose Journal: J Int Assoc Provid AIDS Care Date: 2017-08-10
Authors: Emily L Tuthill; Lisa M Butler; Jennifer A Pellowski; Jacqueline M McGrath; Regina M Cusson; Robert K Gable; Jeffrey D Fisher Journal: Public Health Nutr Date: 2017-02-08 Impact factor: 4.022
Authors: Paul A Shuper; Sandy Pillay; Susan MacDonald; Sarah Christie; Deborah H Cornman; William A Fisher; Jeffrey D Fisher Journal: J Acquir Immune Defic Syndr Date: 2016-07-01 Impact factor: 3.731
Authors: Carolyn M Audet; Sarah A Gutin; Meridith Blevins; Elvino Chiau; Fernanda Alvim; Eurico Jose; Lara M E Vaz; Bryan E Shepherd; Carol Dawson Rose Journal: PLoS One Date: 2015-07-06 Impact factor: 3.240