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Compendium of Evidence-Based HIV Behavioral Interventions

Options/Opciones Project

GOOD-EVIDENCE

Intervention Description

Target Population
HIV-positive clinic patients

Goals of Intervention

  • Eliminate or reduce risky sexual and drug use behaviors

Brief Description

Options/Opciones is an individual-level, clinician-delivered HIV risk reduction intervention for HIV-positive persons during their routine clinical care visits and repeated at each visit. The intervention consists of a brief, patient-centered discussion (5-10 minutes) between clinician and patient at each clinic visit. Based on motivational interviewing techniques, clinicians evaluate sexual and drug-use behaviors of HIV-positive patients, assess the patient’s readiness to change risky (or maintain safer) behaviors, and elicit various methods from patients for moving toward change or maintaining safer behaviors. Clinician and patient then negotiate an individually tailored behavior change goal or plan of action, which is written on a prescription pad, for the participant to achieve by the next visit.

Theoretic Basis

  • Information-Motivation-Behavioral Skills Model (IMB)
  • Motivational interviewing principles

Intervention Duration
A brief 5-10 minute session repeated at each clinic visit over 18 months

Intervention Settings
HIV clinics

Deliverer
HIV care clinicians

Delivery Methods

  • Counseling
  • Goal Setting
  • Risk Reduction Plan

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Intervention Package Information

An intervention package is available from Deborah H. Cornman, PhD, Center for Health, Intervention, and Prevention (CHIP), 2006 Hillside Rd., Unit 1248, University of Connecticut, Storrs, CT 06269-1248. email: deborah.cornman@uconn.edu, for details on intervention materials.

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Evaluation Study and Results

The original evaluation study was conducted in New Haven and Hartford, Connecticut between October 2000 and August 2003.

Key Intervention Effects

  • Reduced unprotected vaginal and anal sex

Study Sample
The baseline study sample of 497 HIV-positive men and women is characterized by the following:

  • 38% African American, 35% Hispanic, 22% White, 5% Other
  • 58% Male, 42% Female
  • 78% heterosexual, 22% gay/bisexual men and women
  • 15% MSM, 26% of men are MSM
  • Mean age of 43, range 22-70 years
  • 56% completed high school education or more

Recruitment Settings
Examination and waiting rooms of two large HIV clinics

Eligibility Criteria
Men and women were eligible if they were at least 18 years of age, had documented HIV infection, and were receiving HIV clinical care.

Assignment Method
Two HIV clinics (497 participants) were assigned to 1 of 2 groups: Options intervention (n = 1 clinic; 252 participants), or standard-of-care control (n = 1 clinic; 245 participants). The intervention and control clinics were selected on the basis of their similarity in population served and structure of services.

Comparison Group
HIV-positive patients in the standard-of-care control group met with their clinicians for scheduled visits and received standard medical care, which did not systematically include HIV prevention discussions.

Relevant Outcomes Measured and Follow-up Time
Sex behaviors during past 3 months (including total number of unprotected insertive or receptive anal or vaginal sexual events with all partners or with partners whose HIV serostatus was negative or unknown) were measured every six months at 6, 12, and 18 months post baseline; since the intervention was given at almost every clinical care visit, the time between intervention delivery and the next assessment averaged between 1 and 4 months.

Participant Retention

  • Options Intervention:
    80% retained at 6 months post baseline
    63% retained at 12 months post baseline
    49% retained at 18 months post baseline
  • Standard-of-care control:
    82% retained at 6 months post baseline
    66% retained at 12 months post baseline
    52% retained at 18 months post baseline

Significant Findings

  • Across the three post-baseline assessments, Options intervention participants reported significantly fewer unprotected anal and vaginal sexual events with any partner than the control group (p = .01).

Considerations

  • This intervention fails to meet the best-evidence criteria due to retention rates < 70% at the12- and 18-month post-baseline assessments.
  • Intervention participants reported fewer unprotected anal and vaginal sexual events with HIV-negative or unknown serostatus partners (p = .06) than comparison participants across the three post-baseline assessments.
  • The findings reported here are based on analysis models adjusted for baseline risk behaviors (required for non-randomized controlled trial) and were obtained directly from the authors.

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References and Contact Information

  • Fisher, J. D., Fisher, W. A., Cornman, D. H., Amico, K. R., Bryan, A., & Friedland, G. H. (2006). Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes, 41(1), 44-52.
  • Fisher, J. D., Cornman, D. H., Osborn, C. Y., Amico, K. R., Fisher, W. A., & Friedland, G. H. (2004). Clinician-initiated HIV risk reduction intervention for HIV-positive persons: Formative research, acceptability, and fidelity of the Options Project. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl. 2), S78-S87.

Researcher: Deborah H. Cornman, Ph.D.
Center for Health, Intervention, and Prevention
2006 Hillside Rd., Unit 1248
University of Connecticut
Storrs, CT 06269-1248
e-mail: deborah.cornman@uconn.edu

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