HIV prevention in clinical settings is feasible and shows results

Participation in a short training programme increases the likelihood of HIV care providers discussing sexual risk behaviour with their patients in routine clinical settings, US research published in the December 15^th edition of the Journal of Acquired Immune Deficiency Syndromes shows. In addition, the patients of providers who received the training reported a significant decrease in their number of sex partners.

“A brief intervention to train HIV providers to identify risk and provide a prevention message results in increased prevention conversations and a reduction in patients’ HIV transmission risk behaviour,” comment the researchers.

Many HIV-positive patients have unprotected sex with partners who are HIV-negative or of unknown infection status. Routine HIV care visits provide an opportunity to discuss risky sexual behaviour and to deliver individualised prevention messages. However, many doctors and other HIV healthcare providers feel that they lack the skills to discuss risk behaviour with their patients.

Therefore investigators from the HIV Intervention for Providers (HIP) study designed a short training session which was intended to give HIV care providers the skills to discuss sex and behavioural risk reduction at routine clinic appointments. The researchers also wanted to see if these discussions lead to a reduction in risky sexual behaviour by patients.

A total of 44 medical providers, from four clinics that provide primary care to HIV-positive patients, were recruited to the study in 2004 and 2005.

These providers looked after a mean of 13 patients and had been working in HIV for an average of eleven years.

Half the providers received four hours of training on how to assess risk behaviour in HIV-positive patients and on the delivery of risk-reduction prevention messages. The other 22 healthcare professionals took the role of controls.

To establish the usefulness of the training, a total of 386 patients who received their care from the providers were also recruited to the study. All these patients reported recent unprotected penetrative sex with a partner who was HIV-negative or of unknown HIV infection status.

At baseline, most of the patients (84%) reported that they had ever discussed sexual behaviour with their healthcare providers and 82% said conversations had included risk reduction.  Overall, the patients reported having unprotected anal or vaginal sex that could involve a risk of HIV transmission with a mean of 2.7 partners in the six months preceding entry to the study.

There was some evidence that the training was successful. After six months of follow-up, the patients of providers who received the training intervention were approximately 50% more likely than individuals who received care from providers in the control arm to report that they had recently discussed safer sex during a clinic appointment (OR = 1.49; 95% CI, 1.06 to 2.09).

In addition, those providers who received training were more likely to assess their patients’ sexual activity (OR = 1.60; 95% CI, 1.05 to 2.45, p < 0.03).

These conversations and assessments had some impact on the sexual behaviour of patients. There was a significant decrease in the number of sex partners reported by the patients of healthcare professionals who participated in the training (from 5 to 4; OR = 0.49, 95% CI, 0.26 to 0.92, p < 0.03). In contrast, the number of sex partners reported by patients of providers in the control arm increased (5 to 8).

However, there was no evidence that the intervention was successful in reducing behaviour most associated with a risk of HIV transmission. At the end of the study, the patients in the two study arms were equally likely to report unprotected penetrative sex with a partner who was HIV-negative or of unknown status. “The need to address risk in this patient population continues to exist,” write the researchers.

Nevertheless, they conclude: “In the HIP intervention, providers played a crucial role in supporting risk reduction.” They add: “Our study shows that even relatively brief provider-level intervention can result in potential risk reduction among persons at high risk for transmitting HIV.”

Dawson Rose C et al. 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, 55: 572-81, 2010.