Abstract #192  -  Implementation of Effective Counseling in the Real World of a Busy STI Clinic
Authors:   Presenting Author:   Prof Cornelis Rietmeijer - Denver Public Health Department
Additional Authors:
Aim: In this presentation, we will discuss the efficacy of client-centered counseling for the prevention of sexually transmitted infections, the barriers towards its implementation in the real world clinical setting, and its possible adaptation to overcome these barriers.
Method / Issue: Client-centered STI prevention counseling is a brief individual intervention comprised of a thorough risk assessment using an open-ended interview technique and a risk reduction plan that involves an achievable, patient-initiated, small step towards a risk reduction goal. Its efficacy was proven in a large multi-site, randomized controlled trial, Project Respect that demonstrated that this intervention reduced new sexually transmitted infections by 30% after 6 months and 20% after 12 months of follow-up compared to giving standard brief educational messages alone. Despite these promising results published over 10 years ago, no sustained efforts have been employed to bring this intervention to scale in STI clinics in the U.S. or elsewhere.
Results / Comments: Reasons for lack of implementation have included lack of provider buy-in and lack of staff resources in an environment where even a brief (20-minute) intervention was perceived as unfeasible and unsustainable. In this presentation, we will briefly review the intervention and the efficacy study. We will then suggest ways to how the major lessons of this intervention might be incorporated into the standard of care in STI clinics. Specifically, we will propose a model where the main concepts of client-centered counseling are incorporated into the standard of care of the provider-client interaction, rather than as a stand-alone behavioral intervention. Experiences at the Denver Metro Health STI clinic will be used to illustrate this approach.
Discussion: While there are many behavioral interventions with proven efficacy in the research setting, their implementation and sustainability in real world prevention practice have been disappointing. In the trajectory of efficacy to effectiveness to impact, there is a need to focus on the practical implementation of interventions within the constraints of the typical practice setting. A scientific approach to this effort is called for.
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