Barcelona 2013
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| Abstract #430 - Information Technologies | ||||
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Session: 17.1: Information Technologies (Parallel) on Monday @ 14.30-16.00 in Mirador Chaired by Ferran Pujol, Rich Wolitski Authors: Presenting Author: Mr Tom Platteau - Institute of Tropical Medicine, Belgium |
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| Additional Authors: | ||||
| Aim: Service providers need evidence-based tools to support people living with HIV (PLHIV) in having healthy sex lives. Eurosupport 6 (a European research network with 10 countries from Western, Southern, and Central/Eastern Europe participating) developed and evaluated a computerized ?positive prevention? intervention for safer sex (CISS) for two key populations: men who have sex with men (MSM), and male and female migrants living with HIV. | ||||
| Method / Issue: CISS is theory-guided, by i.e. Information-Motivation-Behavioral Skills Model, Stages of Change Theory, and Dual process theory on affective decision-making. Counseling techniques include elements of Motivational Interviewing and cognitive?behavioral therapy. CISS consists of 3 counseling sessions, moving from ?Hot Brain? (emotion-focused film-clips) through ?Cool Problem-solving? (interactive exercises and suggested solutions to problems) to ?Cold Planning? (concrete planning linked to personal values). Materials are based on the same theoretical constructs, but adapted to target-group and gender-specific needs. We used a randomized controlled trial (RCT) to evaluate 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). Online self-reported evaluation tools assessed sexual risk and underlying determinants (including mental health, attitudes, motivation, and self-efficacy). Outcome behavior was ?condom use at last intercourse?. For statistical analysis, a logistic mixed effect model was used. Process evaluation data were collected among service providers and participants upon completion of the intervention. | ||||
| Results / Comments: Baseline data were obtained from 192 PLHIV (112 MSM, 80 migrants): 104 (54%) assigned to the intervention, and 88 (46%) to the control group. Fidelity to the intervention was high among participants (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 found between intervention and control group. Condom use at last intercourse differed significantly between intervention and control group at 3 months FU in the hypothesized direction (p=0.041; 95% CI 0.350-8.570), equaling a risk reduction of 30% for intervention participants, but not at 6 months FU (p=0.077; 95% CI 0.015-1.239). Self-efficacy (p=0.003) and attitudes towards condom use (p=0.02) improved significantly over time (in both groups). Self-efficacy improved significantly more in the intervention group (p=0.05). Stratified data-analysis showed that the intervention-effect was retained for MSM at 3 months follow-up, but not for migrants. | ||||
| Discussion: CISS resulted into a significant reduction in unprotected sexual behavior at 3 months FU, attributed to improved self-efficacy and attitudes conducive towards condoms. Introducing a booster session to enhance prevention behavior could potentially contribute to maintaining the intervention effect over longer follow-up periods. 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 effective. | ||||
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