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 15th
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.”