HIV Prevention Counseling Intervention Delivered During Routine Clinical Care Reduces HIV Risk Behavior in HIV-Infected South Africans Receiving Antiretroviral Therapy

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 1891 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 Skills (IMB) model during routine clinical care. Main Outcome Measures Number of sexual events without a condom in the past four 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 to standard-of-care participants. Differences in STI incidence between arms were not observed. Conclusion 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.

One in 4 HIV-Positive South Africans Awaiting ART Initiation Report Condomless Sex With a Serodiscordant Partner

“…This pilot, which commenced in 2011 and focused only on tested-but-not-treated PLWH, was funded as a supplement 21 to a larger randomized controlled trial that involved South African PLWH who had already been initiated on ART. 22 Individuals were deemed as eligible for the intervention pilot if they were 1) 18 years of age or older; 2) HIV-positive; 3) linked to care at one of the four sites; and 4) not yet eligible for ART based on the national treatment guidelines at the time (i.e., CD4 cell count >250 (or >350 if pregnant)). 23 …”

“…Participating PLWH completed an isiZulu or English touchscreen-based audio computer-assisted self-interview (ACASI) that assessed vaginal and anal sex during the past 4 weeks, and potential correlates of risk including demographics, comorbidities (e.g., alcohol use, 24 perceived physical and mental health, 25 and depression 26 ), information-motivation-behavioral skills (IMB) model constructs, and other behavioral factors (e.g., HIV-related stigma, perceived power to use/negotiate condoms) (see 22,27,28 for details). For IMB constructs, “information” items assessed HIV prevention-related knowledge; “motivation” items identified condom-related attitudes and supportive norms for condom use; and “behavioral skills” items queried perceived skills and efficacy regarding the performance of HIV-preventive acts.…”

“…30,31 Similarly, evidence-based behavioral interventions that establish normative support for condoms and provide skills that empower safer sex negotiation could further help curtail HIV transmission. 22 …”

What Level of Risk Compensation Would Offset the Preventive Effect of Early Antiretroviral Therapy? Simulations From the TEMPRANO Trial

“…However, results have shown that this phenomenon can be prevented by offering interventions in combination with traditional prevention methods (such as counselling or condom promotion) (22,23).…”

Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information–Motivation–Behavioural Skills model-based pilot intervention

“…The IMB model targets information, motivation and behavioural skill factors that are conceptually and empirically related to HIV risk and preventive behaviours (see Fig. 1) (15) and has been effectively tested in research among diverse populations worldwide (16,17) . The IMB model has three main assumptions.…”