Authors: Padilla, SM¹; Dillon, B²; Iatesta, M²; Brooks, L³; Raveneau, L⁴; Malotte, CK¹; McKleroy, V; and the RESPECT-2 Study Group

¹California State University Long Beach, Long Beach, CA; ²Centers for Disease Control and Prevention, Atlanta, GA; ³Denver Public Health, Denver, CO; ⁴North Jersey Community Research Initiative, Newark, NJ

Issue: Rapid HIV tests allow clients to be tested and receive their result during a single clinic visit, eliminating the need for a return visit in those whose result is negative.

Setting: Public STD clinics in Long Beach, Denver, and Newark.

Project: RESPECT-2 is an ongoing multi-site randomized controlled trial comparing the efficacy of rapid HIV test counseling (RTC) with 2 consecutive sessions in a single visit, and standard HIV testing with 2 counseling sessions 1 to 2 weeks apart. Both use a modified version of a counseling protocol shown to be effective at reducing STDs in a previous study (Project RESPECT). To date, RTC has been provided to more than 1,600 participants in 3 cities. Counselor supervisors at the 3 sites conducted individual and small-group interviews with 9 counselors about their perceptions of RTC, using a standardized interview guide.

Results: Five of 9 counselors reported being apprehensive about conducting RTC initially. The 4 without initial concerns all joined the study after sites had gained experience at RTC. Although 8 of 9 counselors were uncomfortable about disclosing preliminary-positive results, once familiar with RTC 8 of 9 counselors preferred RTC to standard 2-session counseling. Perceived advantages of RTC included: a belief that the continuity of doing a risk-assessment and giving the HIV result the same day improves counseling (n=6); an observation that clients appeared more focused on their risk issues (n=5); and that it ensures that nearly all clients receive their HIV result and a second counseling session (n=9). All counselors believed that providing the HIV result the same day was more convenient for both clients and counselors. Perceived disadvantages of RTC were: client fatigue (n=6); the challenge of allocating a larger block of time in order to conduct 2 consecutive sessions (n=9); and not having an opportunity to speak to the client after counselor and client had time to reflect on risk-issues and the client had time to try the risk-reduction plan (n=7).

Lessons learned: From a counselor perspective, the advantages of RTC outweigh the disadvantages for both counselor and client. However, the efficacy of RTC relative to standard 2-session counseling is not yet known.