Strategies to Reduce HIV Risk Behavior in HIV Primary Care Clinics: Brief Provider Messages and Specialist Intervention

Abstract

Reducing HIV transmission is a critical goal worldwide, prompting new strategies to slow the spread of the virus. This paper describes the theoretical underpinnings of the Comprehensive Harm Reduction Protocol (CHRP) and the process of its implementation in one large urban HIV clinic and two smaller rural primary care clinics. Patients enrolled in CHRP complete the Risk Diagnostic Questionnaire (RDQ), self-reporting HIV transmission risk behavior at most clinic visits. Clinicians review RDQs to trigger dialogue using motivational interviewing and the stages of health behavior change to reduce high-risk behaviors (drug use, alcohol use, or high-risk sexual behavior). In the ongoing evaluation study, CHRP patients receive two provider-only visits before being randomized to continue with provider brief prevention messages only or to receive additional intensive counseling with a risk-reduction specialist following the provider visit. If outcome data support one or both interventions, CHRP could be a useful model for widespread adoption. Observations from the implementation of this protocol are presented in order to facilitate the adoption of this protocol in interested clinics. Later, results of the evaluation of the implementation of the protocol may have value in developing prevention policy in HIV treatment clinics.

HIV Care Providers' Implementation of Routine Alcohol Reduction Support for Their Patients

“…This, together with the complexity of many patients' issues and the attention that these issues require, present substantial barriers to finding the time to implement alcohol reduction support during patients' visits. [51][52][53] Thus, from a practical standpoint, these providers may need to use a ''specialist'' approach, 19 referring patients to other professionals in their programs who have more time and expertise to effectively counsel patients regarding their alcohol reduction needs. 54 Several limitations of the research need to be acknowledged.…”

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

“…To address this secondary prevention need, the Health Resources and Services Administration funded an initiative to develop and evaluate secondary prevention interventions delivered in the context of primary care settings [54]. While a number of papers have reported on the development and implementation of such intervention programs [55–58], two recent studies report outcomes from secondary prevention interventions delivered by medical providers in primary HIV care [59, 60]. …”

Prevention With Positives: A Review of Published Research, 1998-2008

“…Brief (,10 minute) individual interventions have been reported to significantly reduce risk behaviors (Fisher et al, 2006;Gardner et al, 2008;Richardson et al, 2004). Other brief (,10 minute) individual interventions are being evaluated by Callahan, Flynn, Kuenneth, and Enders (2007), Grimley, Bachmann, Jenckes, and Erbelding (2007), and Zuniga et al (2007).…”

“…These trials include those described by Callahan et al (2007), Fisher et al (2006, Gardner et al (2008), Grimley et al (2007), Richardson et al (2004), and Zuniga et al (2007). Interim results have been reported from three of these trials.…”

“…Callahan et al (2007) evaluated the effects of a provider-delivered intervention compared with an enhanced intervention that used the health care provider intervention followed by an HIV prevention specialist intervention. In a similar study, Zuniga et al (2007) compared a consequence-framed prevention message to the same message followed by four sessions with an HIV prevention specialist.…”