Abstract #2710  -  Eurosupport 6: Effectiveness of a computer-assisted intervention to reduce sexual risk behaviour among people living with HIV (MSM and migrants)
Authors:   Presenting Author:   Dr. Christiana Nöstlinger - Institute of Tropical Medicine
Additional Authors:  Dr.  Tom Platteau, Dr. Buyze  Jozefien, Dr. John Helps, Dr. Agnes Kocsis , & the Eurosupport 6 Study Group .,
Aim: Eurosupport 6 (i.e. European research network with 10 European countries participating) developed and evaluated computer-assisted tools to improve the sexual and reproductive health for people living with HIV (PLHIV), more specifically to reduce sexual risk behaviour. The intervention targeted two key populations: men who have sex with men (MSM), and male and female migrants living with HIV.
Method / Issue: Intervention development (?CISS?: computerized intervention for Safer Sex) was guided by the Intervention mapping Method. The CISS development was based on ed behavioural theories, i.e. Information-Motivation-Behavioral Skills Model, Stages of Change Theory, and Dual process theory on affective decision-making. Counseling techniques included elements of Motivational Interviewing and cognitive?behavioural therapy. Trained counselors made use of computerised tools, such as video clips and animated-learning materials available on a DVD to guide participants though three counseling sessions. A randomized controlled trial evaluated the intervention?s effectiveness at 3 and 6 months follow-up (FU) compared to baseline assessment. Participants were assigned to experimental (CISS) vs. control condition (treatment-as-usual). Sexual risk and underlying determinants were evaluated using online self-reported questionnaires. Outcome measure was ?condom-use at last intercourse? using a logistic mixed effect model to detect changes. Process evaluation data were also collected.
Results / Comments: Baseline stem from 192 PLHIV (112 MSM, 80 migrants of whom 104 or 54% were assigned to the intervention, and 88 or 46% to the control group). Fidelity to the intervention was high (95% completed all sessions) but attrition rate was 44% at 3 months FU. At baseline no differences relating to condom use (p=0.501 95% CI 0.007-0.897) or relevant determinants were detected between intervention and control group. Condom use at last intercourse differed significantly between intervention and control group at 3 months FU (p=0.041 95% CI 0.350-8.570), equaling a risk reduction of 30% for CISS participants. Effects were not sustained at 6 months FU (p=0.077 95% CI 0.015-1.239). Stratified data-analysis showed that the intervention-effect was retained for MSM at 3 months follow-up, but not for migrants.
Discussion: The intervention resulted into a significant reduction in unprotected sexual behavior at 3 months FU, attributed to improved self-efficacy and attitudes conducive towards condoms. Study limitation was the small sample size, resulting in reduced scientific power of the evaluation. During the implementation phase we faced barriers for enrolment situated at legal (HIV criminalization), organizational (time constrains, referral from health care providers), and individual (fear of being judged, financial constraints) level. Counselors were highly motivated to integrate CISS materials in routine service provision to support PLHIV in adopting safer and healthier sex lives. Participants found the materials to be supporting and effect. Based on this results, a training and resource package was developed containing intervention- and training materials. Project information and materials can be accessed at: www.eurosupportstudy.net
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