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Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention

RESPECT

Brief Counseling

BEST-EVIDENCE

Enhanced Counseling

GOOD-EVIDENCE

Intervention Description

Target Population
Heterosexual, HIV-negative, STD clinic patients

Goals of Intervention

  • Eliminate or reduce sex risk behaviors
  • Reduce STD infections

Brief Description

There are two RESPECT interventions – Brief Counseling (Best-evidence) and Enhanced Counseling (GOOD-EVIDENCE). Both are one-on-one, client-focused HIV/STD prevention counseling interventions, consisting of either 2 (Brief) or 4 (Enhanced) interactive counseling sessions. In the first session (20 minutes) of both Brief and Enhanced Counseling interventions, HIV counselors help STD clinic patients to identify personal risk factors and barriers to risk reduction and work with patients to develop an achievable personalized risk-reduction plan. HIV-antibody testing is offered at the end of the first session. The second session of the Brief Counseling intervention (20 minutes) includes a discussion of the HIV test result and additional counseling to support patient-initiated behavior change and help patients develop a longer-term risk-reduction plan. Patients in the Enhanced Counseling intervention receive three weekly 60-minutes counseling sessions in addition to the first session. The additional sessions address condom use attitudes, social norms and support for condom use, build condom use self-efficacy, discuss prior week's behavior change success and barriers, and develop a strategy for taking a risk-reduction step before the next session. HIV test result is given at the end of the third session and a longer-term personalized risk reduction plan is developed at the last session.

Theoretic Basis

  • Social Cognitive Theory
  • Theory of Reasoned Action

Intervention Duration
Brief Counseling: Two 20-minute sessions (40 minutes total) delivered over 7-10 days
Enhanced Counseling: One 20-minute and three 60-minute sessions (200 minutes total) delivered over 3-4 consecutive weeks

Intervention Settings
Public STD clinics

Deliverer
Trained HIV/STD Counselors

Delivery Methods

  • Counseling
  • Exercise
  • Goal setting
  • Printed Materials
  • Risk Reduction Supplies (condoms)

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Intervention Package Information

An intervention package was developed with funding from CDC’s Replicating Effective Programs (REP) Project. The intervention package and training are available through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project.

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Evaluation Study and Results

The original evaluation study was conducted in Baltimore, Maryland; Denver, Colorado; Newark, New Jersey; and Long Beach and San Francisco, California between 1993 and 1996.

Key Intervention Effects

  • Reduced new STD infections
  • Reduced unprotected sex
  • Increased other safer sex behaviors

Study Sample
The baseline study sample of 5,758 STD clinic patients is characterized as follows:

  • 59% African American, 19% Hispanic, 16% White, 6% Other
  • 57% Male, 43% Female
  • 100% heterosexual
  • Median age of 25 years
  • Median education of 12 years

Recruitment Settings
Public STD clinics

Eligibility Criteria
STD clinic patients were eligible if they tested HIV-negative and were 14 years of age or older. Men who reported having a male sex partner in the past 12 months or who identified as bisexual or homosexual were excluded.

Assignment Method
STD clinic patients (N = 5,758) were randomly assigned to 1 of 4 groups: Brief Counseling (n = 1,447), Enhanced Counseling (n = 1,438), Didactic Messages (n= 1,443), or Didactic Messages without follow-up (n = 1,430).

Comparison Group
The Didactic Messages group received two one-on-one informational sessions (5 minutes per session, one before and one after HIV-antibody testing) delivered by a HIV/STD prevention clinician. Brief messages about HIV and STDs are similar to didactic messages typical of usual STD care.

Relevant Outcomes Measured and Follow-up Time

  • Incident STDs (including Gonorrhea, Syphilis, Chlamydia, and HIV) were confirmed by laboratory tests and measured at 6 and 12 months after baseline, which translates to approximately 5 and 11 months after intervention.
  • Sex behaviors during past 3 months (including condom use during anal and vaginal intercourse, number of sex partners) or at last sex (including condom use with primary, causal, or new partner) were measured at 3, 6, 9, and 12 months after baseline, which translates to approximately 2, 5, 8, and 11 months after intervention.

Participant Retention

  • Brief Counseling:
    71% retained at 5 months after intervention
    67% retained at 11 months after intervention
  • Enhanced Counseling:
    68% retained at 5 months after intervention
    65% retained at 11 months after intervention
  • Didactic Messages:
    70% retained at 5 months after intervention
    67% retained at 11 months after intervention

Significant Findings

Brief Counseling intervention compared to Didactic Messages (Best Evidence):

  • The Brief Counseling intervention group had a significantly lower rate of new STD infections over the 5 and 11 months after intervention (all ps < .05) than the comparison group.
  • A significantly greater percentage of Brief intervention participants reported no unprotected vaginal intercourse than comparison participants at 5 months after intervention (p < .05).
  • Additionally, the following findings met the promising evidence criteria: at 2 months after intervention, a significantly greater percentage of Brief intervention participants than comparison participants reported no unprotected vaginal intercourse, ≤ 1 sex partner, no causal partners, no new sex partner, and condom use with other partners during last sex episode (all p's < .05).

Enhanced Counseling compared to Didactic Messages (Promising Evidence):

  • The Enhanced intervention group had a significantly lower rate of new STD infections over the 5-month and 11-month periods after intervention (all ps < .05) than the comparison group.
  • At 2 months after intervention, a significantly greater percentage of Enhanced participants than comparison participants reported no unprotected vaginal intercourse, any condom used, and having ≤ 1 sex partner in past 3 months, and condom use with primary partner and condom use with other partner in the last sex (all ps < .05). A significant intervention effect was also found for any condom use at 5 months after intervention (p < 0.05).

Considerations

  • The Brief Counseling intervention is considered to meet the best-evidence criteria. The Enhanced Counseling intervention did not meet the best-evidence criteria due to the retention rates, but met the GOOD-EVIDENCE criteria.
  • While both Brief and Enhanced Counseling interventions are effective in reducing new STD infections over the 5-month and 11-month periods after intervention, the intervention effects on sex risk behaviors were not found to be significant beyond 5 months after intervention.

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References and Contact Information

  • Kamb, M. L., Fishbein, M., Douglas, J. M., Rhodes, F., Rogers, J., Bolan, G., et al. (1998). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial. Journal of American Medical Association, 280, 1161-1167.

Researcher: Dr. Mary L. Kamb
Centers for Disease Control and Prevention
1600 Clifton Road NE, Mailstop E-02
Atlanta, GA 30333
email: mkamb@cdc.gov 

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