Authors: Iatesta M¹; Dillon B¹; Padilla S², Brooks L³; Raveneau L⁴; Metcalf C¹.

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

Background: RESPECT-2 is a large ongoing multi-center randomized controlled trial comparing the efficacy of two brief HIV testing and counseling interventions aimed at reducing STD incidence in STD clinic patients. Participants are followed-up for one year after the intervention to assess STD incidence and changes in risk behavior.

Objectives: 1) To describe a protocol for HIV/STD prevention counseling with a rapid HIV test; 2) To describe methods used to assure quality prevention counseling and adherence to counseling protocols.

Methods: Participants are assigned to either standard HIV testing and 2 counseling sessions 1 week apart using a structured proven-effective prevention counseling protocol, or rapid HIV testing and 2 counseling sessions the same visit using a modified prevention counseling protocol (see www.cdc.gov/hiv/topics/research/respect-2/). Participants develop personal risk-reduction plans, irrespective of the HIV testing and counseling method.

About 15% of counseling sessions are observed by a trained supervisor or audiotaped for quality assurance (QA) purposes. Supervisors use a structured evaluation form to assess adherence to counseling protocols. Counselors are given regular feedback and mentoring to improve their counseling skills.

Results: Preliminary results indicate that the modified counseling protocol is acceptable to counselors and clients, and can be completed as recommended. To date, 78% of participants have consented to having counseling sessions audiotaped. Counselors are receptive to routine ongoing counseling QA, respond positively to feedback, and have become adept at adhering to counseling protocols.

Conclusions: Prevention counseling with rapid HIV testing and same-visit HIV results, is feasible but efficacy is not yet known. Audiotaping or observation for QA purposes, is accepted by most clients. Implementing counseling QA, using a structured QA protocol, is useful to ensure consistent quality counseling.