Positive Choice: Prevention for Positive Health
| Status: | Completed |
|---|---|
| Conditions: | HIV / AIDS |
| Therapuetic Areas: | Immunology / Infectious Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/13/2017 |
| Start Date: | December 2003 |
| End Date: | September 2006 |
This is a randomized, controlled trial of Positive Choice, an interactive multimedia
computer program, to determine whether it can detect and reduce risky behaviors among
HIV-positive adults. The behaviors of interest are: unprotected anal or vaginal intercourse,
illicit drug use, risky alcohol drinking, and failure to disclose HIV status to sex
partners. The Positive Choice program is integrated into the routine operations of
outpatient HIV clinics, where participating patients complete an in-depth risk assessment
(computerized health questionnaire) before a regularly scheduled medical appointment.
Participants assigned to the intervention arm receive brief, interactive risk-reduction
counseling by an actor-portrayed Video Doctor and an educational worksheet. Their health
care provider receives as summary cueing sheet, alerting them to the patient's risky
behavior and readiness to change. Control participants complete the computerized risk
assessment and receive the clinic's usual care. Three months after a baseline visit,
intervention and control group patients are invited back to complete an additional risk
assessment. The intervention group also receives a "booster" intervention. Six months after
baseline, both groups complete a final risk assessment.
computer program, to determine whether it can detect and reduce risky behaviors among
HIV-positive adults. The behaviors of interest are: unprotected anal or vaginal intercourse,
illicit drug use, risky alcohol drinking, and failure to disclose HIV status to sex
partners. The Positive Choice program is integrated into the routine operations of
outpatient HIV clinics, where participating patients complete an in-depth risk assessment
(computerized health questionnaire) before a regularly scheduled medical appointment.
Participants assigned to the intervention arm receive brief, interactive risk-reduction
counseling by an actor-portrayed Video Doctor and an educational worksheet. Their health
care provider receives as summary cueing sheet, alerting them to the patient's risky
behavior and readiness to change. Control participants complete the computerized risk
assessment and receive the clinic's usual care. Three months after a baseline visit,
intervention and control group patients are invited back to complete an additional risk
assessment. The intervention group also receives a "booster" intervention. Six months after
baseline, both groups complete a final risk assessment.
A preliminary analysis of baseline data was conducted in January 2006, which indicated that
the Positive Choice intervention achieved significant reductions in drug use. These findings
were reported in a poster presentation at the XVI International AIDS Conference in Toronto,
Canada, in August 2006. A final analysis of outcomes data was conducted in fall 2006
(September - December). Aggregate results from all five study sites are summarized below.
We found a high prevalence of risky behaviors in our sample (497/918, or 54%) and achieved
high retention for follow-up in both groups (>80%). We found significant elimination of any
drug use in the intervention group at both follow-ups. Among all participants who reported
drug use at baseline, 66% of intervention participants continued their drug use at 3-month
follow-up compared to 85% of control participants (OR 0.356, p<0.01). At 6-month follow-up,
59% of intervention participants continued their drug use compared to 88% of the control
group (<0.001). Among participants who reported methamphetamine use at baseline, 58%
continued their methamphetamine use at 3-month follow-up compared to 83% of control
participants (OR 0.285, p=0.02). At 6-month follow-up, 53% of intervention participants
continued their methamphetamine use compared to 73% of the control group (OR 0.344, p=0.03).
We also found significantly less unprotected sex with casual partners by intervention
participants at 3-month follow up (69% vs. 87%, OR 0.313, p=0.04), and fewer intervention
participants who exceeded the recommended number of drinks per week at 3-months (53% vs.
78%, OR 0.310, p=0.02) Our findings indicate that the Positive Choice program was effective
at reducing important behavioral risks among HIV-positive adults in care. Positive Choice is
an appropriate and effective adjunct to routine medical care for HIV-positive adults.
the Positive Choice intervention achieved significant reductions in drug use. These findings
were reported in a poster presentation at the XVI International AIDS Conference in Toronto,
Canada, in August 2006. A final analysis of outcomes data was conducted in fall 2006
(September - December). Aggregate results from all five study sites are summarized below.
We found a high prevalence of risky behaviors in our sample (497/918, or 54%) and achieved
high retention for follow-up in both groups (>80%). We found significant elimination of any
drug use in the intervention group at both follow-ups. Among all participants who reported
drug use at baseline, 66% of intervention participants continued their drug use at 3-month
follow-up compared to 85% of control participants (OR 0.356, p<0.01). At 6-month follow-up,
59% of intervention participants continued their drug use compared to 88% of the control
group (<0.001). Among participants who reported methamphetamine use at baseline, 58%
continued their methamphetamine use at 3-month follow-up compared to 83% of control
participants (OR 0.285, p=0.02). At 6-month follow-up, 53% of intervention participants
continued their methamphetamine use compared to 73% of the control group (OR 0.344, p=0.03).
We also found significantly less unprotected sex with casual partners by intervention
participants at 3-month follow up (69% vs. 87%, OR 0.313, p=0.04), and fewer intervention
participants who exceeded the recommended number of drinks per week at 3-months (53% vs.
78%, OR 0.310, p=0.02) Our findings indicate that the Positive Choice program was effective
at reducing important behavioral risks among HIV-positive adults in care. Positive Choice is
an appropriate and effective adjunct to routine medical care for HIV-positive adults.
Inclusion Criteria:
- 18 years or older,
- HIV-positive 3 months or longer,
- English speaking; and
- Receiving medical care at a participating clinic.
Exclusion Criteria:
- Less than 18 years old,
- HIV-positive less than 3 months,
- Non-English speaking; and
- Not receiving medical care at a participating clinic.
We found this trial at
5
sites
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