Interventions Delivered in Clinical Settings are Effective in Reducing Risk of HIV Transmission Among People Living with HIV: Results from the Health Resources and Services Administration (HRSA)’s Special Projects of National Significance Initiative

Abstract

To support expanded prevention services for people living with HIV, the US Health Resources and Services Administration (HRSA) sponsored a 5-year initiative to test whether interventions delivered in clinical settings were effective in reducing HIV transmission risk among HIV-infected patients. Across 13 demonstration sites, patients were randomized to one of four conditions. All interventions were associated with reduced unprotected vaginal and/or anal intercourse with persons of HIV-uninfected or unknown status among the 3,556 participating patients. Compared to the standard of care, patients assigned to receive interventions from medical care providers reported a significant decrease in risk after 12 months of participation. Patients receiving prevention services from health educators, social workers or paraprofessional HIV-infected peers reported significant reduction in risk at 6 months, but not at 12 months. While clinics have a choice of effective models for implementing prevention programs for their HIV-infected patients, medical provider-delivered methods are comparatively robust.

Helping Patients Talk About HIV: Inclusion of Messages on Disclosure in Prevention with Positives Interventions in Clinical Settings

“…Our findings suggest that the interventions provided tools for patients to feel more at ease disclosing and communicating with sex partners about sexual risk. The influence of the interventions on disclosure correspond to quantitative findings reported elsewhere (Myers et al, 2010) that these PwP interventions helped produce a shift in patients' risk towards safer sex practices.…”

Disclosure, Knowledge of Partner Status, and Condom Use Among HIV-Positive Patients Attending Clinical Care in Tanzania, Kenya, and Namibia

“…However, the high rates of disclosure and condom use observed in this analysis are consistent with other studies conducted among PLHIV who knew their HIV status and were attending clinical care. [51][52][53] All participants in this sample were PLHIV attending clinical care in a country with a …”

People Living with HIV are Receptive to HIV Prevention Interventions in Clinical Settings: A Qualitative Evaluation

“…Results from the quantitative evaluation indicated that interventions delivered by either providers or specialists were effective in reducing sexual risk behavior (Myers et al, 2010). In particular, messages delivered by specialists influenced behavior change in the shorter term, while provider-delivered messages were effective and durable (Myers et al, 2010).…”

“…In particular, messages delivered by specialists influenced behavior change in the shorter term, while provider-delivered messages were effective and durable (Myers et al, 2010). The number of HIV infections averted depended on the type of intervention, but ranged from 2 cases averted in the assessment-only condition to 6 cases averted in the provider-delivered interventions.…”

“…Research on the effectiveness of PwP is on-going; to date there are a number of proven effective PwP interventions (Fisher & Smith, 2009;Gilbert et al, 2008;Myers et al, 2010). The study of PwP in clinical settings remains an area of research of considerable importance (Drainoni, Dekker, Lee-Hood, Boehmer, & Reif, 2009;Fisher & Smith, 2009;Fisher et al, 2006;Gilliam & Straub, 2009;Grodensky et al, 2008;Illa et al, 2010;Richardson et al, 2004) in order expand our understanding of whether PwP in clinical settings is a sustainable HIV prevention strategy.…”