Effects of a Behavioral Intervention to Reduce Risk of Transmission Among People Living With HIV

Morin, Stephen F.; Chesney, Margaret A.; Ehrhardt, Anke Α.; Kelly, Jeffrey A.; Pequegnat, Willo; Rotheram‐Borus, Mary Jane; Afifi, Abdelmonem A.; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Charlebois, Edwin D.; Cumberland, William G.; DesJarlais, Don C.; Duan, Naihua; Exner, Theresa M.; Goldstein, Risë B.; Gore‐Felton, Cheryl; Hirky, A. Elizabeth; Johnson, Mallory O.; Kertzner, Robert M.; Kirshenbaum, Sheri B.; Kittel, Lauren; Klitzman, Robert; Lee, Martha; Levin, Bruce; Lightfoot, Marguerita; Pinkerton, Steven D.; Remien, Robert H.; Rhodes, Fen; Song, Juwon; Steward, Wayne T.; Tross, Susan; Weinhardt, Lance S.; Weiss, Robert E.; Wolfe, Hannah; Wolfe, Rachel; Wong, F. Lennie; Batterham, Philip J.; Comulada, W. Scott; Rogers, Tyson; Zhao, Yu; Correale, Jackie; Hackl, Kristin L.; Hong, Daniel; Huchting, Karen; Mickalian, Joanne D.; Peterson, Margaret; Gordon, Christopher M.; Rausch, Dianne M.; Stover, Ellen

doi:10.1097/qai.0b013e31802c0cae

Cited by 107 publications

(45 citation statements)

References 24 publications

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“…We did not make requests to the scientific community (e.g., listserv) and/or to individual authors with relevant research, so unpublished or in print RCTs were not included. In addition, four trials were excluded because we did not get needed data for analysis from the investigators [34], [35], [36], [37]. Second, non-English databases were not included in our systematic searching; therefore, data from papers published in other languages might have been missed.…”

Section: Discussionmentioning

confidence: 99%

“…SMD in each study arm was calculated as the difference of mean at follow-up and baseline divided by the pooled standard deviation (SD) of these two means [33]. We contacted available authors when published articles provided insufficient information to make the calculations; four studies were excluded because insufficient data was provided by study authors [34], [35], [36], [37]. As study arms might not be comparable at baseline, even in RCTs, Becker's strategy was used to adjust for baseline UVAI between study arms [33].…”

Section: Methodsmentioning

confidence: 99%

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Sexual Risk Reduction for HIV-Infected Persons: A Meta-Analytic Review of “Positive Prevention” Randomized Clinical Trials

Wang

Vermund

et al. 2014

PLoS ONE

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BackgroundPrevention intervention trials have been conducted to reduce risk of sexual transmission among people living with HIV/AIDS (PLWHA), but the findings were inconsistent. We performed a systematic review and meta-analysis to evaluate overall efficacy of prevention interventions on unprotected vaginal or anal intercourse (UVAI) among PLWHA from randomized clinical trials (RCTs).MethodsRCTs of prevention interventions among PLWHA published as of February 2012 were identified by systematically searching thirteen electronic databases. The primary outcome was UVAI. The difference of standardized mean difference (SMD) of UVAI between study arms, defined as effect size (ES), was calculated for each study and then pooled across studies using standard meta-analysis with a random effects model.ResultsLower likelihood of UVAI was observed in the intervention arms compared with the control arms either with any sexual partners (mean ES: −0.22; 95% confidence interval [CI]: −0.32, −0.11) or with HIV-negative or unknown-status sexual partners (mean ES and 95% CI: −0.13 [−0.22, −0.04]). Short-term efficacy of interventions with ≤10 months of follow up was significant in reducing UVAI (1–5 months: −0.27 [−0.45, −0.10]; 6–10 months: −0.18 [−0.30, −0.07]), while long-term efficacy of interventions was weaker and might have been due to chance (11–15 months: −0.13 [−0.34, 0.08]; >15 months: −0.05 [−0.43, 0.32]).ConclusionsOur meta-analyses confirmed the short-term impact of prevention interventions on reducing self-reported UVAI among PLWHA irrespective of the type of sexual partner, but did not support a definite conclusion on long-term effect. It is suggested that booster intervention sessions are needed to maintain a sustainable reduction of unprotected sex among PLWHA in future risk reduction programs.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Sexual Risk Reduction for HIV-Infected Persons: A Meta-Analytic Review of “Positive Prevention” Randomized Clinical Trials

Wang

Vermund

et al. 2014

PLoS ONE

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“…In 2009, Fisher and colleagues [20•] reviewed 11 secondary prevention studies conducted with US and international PLWHA [42–52]. Unlike earlier interventions for PLWHA that typically utilized a small group format, studies chronicled in this review utilized a diverse range of intervention approaches to reduce sexual risk behavior.…”

Section: Summary Of Previous Secondary Prevention Reviewsmentioning

confidence: 99%

Secondary HIV Prevention: Novel Intervention Approaches to Impact Populations Most at Risk

Brown

DiClemente

2011

Curr HIV/AIDS Rep

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This paper reviews recent secondary prevention interventions designed to reduce sexual risk behaviors among people living with HIV/AIDS (PLWHA). A summary of findings from previous meta-analyses and narrative reviews of interventions is provided. Next, novel HIV prevention approaches for PLWHA are reviewed. The review reports on the efficacy of interventions delivered in primary care settings or by technology-formats, interventions that also address mental health difficulties, and programs to address particular at-risk populations (eg, men who have sex with men). A critique of recent interventions for people living with HIV/AIDS is provided as well as suggestions for future research.

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“…23,24 There is similar evidence for sexual risk reduction on the order of 15% to up to 30% in control groups in some HIV prevention trials with both HIV-negative 25,26 and HIV-positive participants. 27,28 Qualitative process studies of ATOD intervention trials find that participants recognize the impact of assessments on their behaviors and that more frequent monitoring might result in greater effects. 23 …”

Section: Introductionmentioning

confidence: 99%

Smartphone Self-Monitoring to Support Self-Management Among People Living With HIV

Swendeman¹,

Ramanathan

Baetscher³

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH). METHODS PLH (n=50), primarily African-American and Latino, were recruited from two AIDS services organizations and randomly assigned to daily smartphone (n=34) or bi-weekly web-survey only (n=16) self-monitoring for six weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine bi-weekly, open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains. RESULTS Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, non-judgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than bi-weekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared to bi-weekly web-survey only participants. CONCLUSION Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption and sustainability.

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Effects of a Behavioral Intervention to Reduce Risk of Transmission Among People Living With HIV

Abstract: Cognitive behavioral intervention programs can effectively reduce the potential of HIV transmission to others among PLH who report significant transmission risk behavior.

Cited by 107 publications

References 24 publications

Sexual Risk Reduction for HIV-Infected Persons: A Meta-Analytic Review of “Positive Prevention” Randomized Clinical Trials

Sexual Risk Reduction for HIV-Infected Persons: A Meta-Analytic Review of “Positive Prevention” Randomized Clinical Trials

Secondary HIV Prevention: Novel Intervention Approaches to Impact Populations Most at Risk

Smartphone Self-Monitoring to Support Self-Management Among People Living With HIV

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