Objective
To conduct a systematic
review to examine interventions for reducing HIV risk behaviors among people
living with HIV (PLWH) in the United States.
Methods
Systematic searches included
electronic databases from 1988 to 2012, hand searches of journals, reference
lists of articles, and HIV/AIDS Internet listservs. Each eligible study was
evaluated against the established criteria on study design, implementation,
analysis, and strength of findings to assess the risk of bias and intervention
effects.
Results
Forty-eight studies were
evaluated. Fourteen studies (29%) with both low risk of bias and significant
positive intervention effects in reducing HIV transmission risk behaviors were
classified as evidence-based interventions (EBIs). Thirty-four studies were
classified as non-EBIs due to high risk of bias or non-significant positive
intervention effects. EBIs varied in delivery from brief prevention messages to
intensive multi-session interventions. The key components of EBIs included
addressing HIV risk reduction behaviors, motivation for behavioral change,
misconception about HIV, and issues related to mental health, medication
adherence, and HIV transmission risk behavior.
Conclusion
Moving evidence-based
prevention for PLWH into practice is an important step in making a greater
impact on the HIV epidemic. Efficacious EBIs can serve as model programs for
providers in healthcare and non-healthcare settings looking to implement
evidence-based HIV prevention. Clinics and public health agencies at the state,
local, and federal levels can use the results of this review as a resource when
making decisions that meet the needs of PLWH to achieve the greatest impact on the
HIV epidemic.
Table 1
Descriptive Characteristics of 48 HIV Behavioral Interventions for People Living with HIV (PLWH)
| Category | First Author [Citation Number], Study Years, Region | HIV-positive Subpopulation (Baseline Sample Size) | Study Design, Comparison Group | Intervention Name (# of sessions/ total hours), Intervention Level | Sex, Drug and Biological Outcomes |
|---|---|---|---|---|---|
| EBI | El-Bassel et al. [36], 2003–2008, S, NE, W | African-American HIV serodiscordant heterosexual couples (1070) | RCT, Attention control | Project EBAN (8/16), Couple | Sex outcome Significant positive intervention effects on TRB: (1) higher mean proportion of condom-protected sex during anal or vaginal sex at 6 months after intervention: (RR=1.22, 95% CI: 1.05 to 1.41, p=.01); (2) consistent condom use during anal or vaginal sex at 6 months after intervention (RR=1.57, 95% CI: 1.27 to 1.94, p<.001) and at 12 months after intervention (RR=1.40, 95% CI: 1.13 to 1.75, p=.003); (3) lower log mean of unprotected anal or vaginal sex at 6 months after intervention (difference = −1.79, 95% CI: −2.50 to −1.08, p<.001) and at 12 months after intervention (difference = −1.15, 95% CI: −1.88 to −0.42, p=.002). No significant effect: the number of concurrent TRB partners at 6 months (RR=0.96, 95% CI=0.71 to 1.29, p=.95) and 12 months (RR=1.01, 95% CI = 0.78 to 1.30, p=.95) after intervention. Biologic outcome No significant effect on the cumulative incidence of STDs (chlamydia, gonorrhea, or trichomonas) over the 12- month assessment period (RR=0.98, 95% CI; 0.62 to 1.56., p=.93). The overall HIV seroconversion at the 12-month assessment was 5 (2 in the intervention group and 3 in the comparison group) – analysis not powered to detect difference in HIV seroconversion. |
| EBI | Fisher et al. [37], 2000–2003, NE | HIV clinic patients (497) | Non-RCT, Standard of care | Options/Opcio nes (5–10 minutes per clinic session), Individual | Sex outcome Significant positive intervention effects on TRB and other outcomes across the 6-, 12-, and 18-month post-baseline assessments: (1) fewer unprotected anal or vaginal TRB (b = −.28, se =.15, p=.05)a; (2) fewer unprotected anal or vaginal sex acts with any partners (b = −.38, se =.15, p=.012)a. |
| EBI | Gilbert et al. [39], 2003–2006, W | HIV clinic patients (471) | RCT, Standard of care | Positive Choice: Interactive Video Doctor (2/0.75), Individual | Sex outcome Significant positive intervention effects: (1) less likely to report unprotected anal or vaginal sex at 3 months after the initial counseling session (RR=0.88, 95% CI = 0.773 to 0.993, p=.039) and at 3 months after the booster counseling (RR=0.80, 95% CI=0.686 to 0.941, p=.007); (2) fewer number of casual sex partners at 3 months after the booster counseling (−2.7 vs. − 0.6, p=.042). No significant effect on the absolute percent change in condom use with main partners or with casual partners at the 2 assessments (p>.05). |
| EBI | Golin et al. [40], 2006–2009, S | Sexually active adult clinic patients (490) | RCT, Attention control | Motivational Interviewing (4/4) Individual | Sex outcome Significant positive intervention effects on TRB: greater reduction in unprotected anal or vaginal TRB at 4 months after intervention (b= −1.86,se= 0.92, p=.04). No significant effect on the reduction in unprotected vaginal or anal sex acts with any partners at 4 months after intervention (b= −0.71, se= 0.70, p=.32). |
| EBI | Kalichman et al. [44], 1997–1998, S | None (328) | RCT, Attention control | Healthy Relationships (5/10), Group | Sex outcome Significant positive intervention effects on TRB and other outcomes: (1) fewer unprotected anal or vaginal TRB at 3 months (F=4.7, p=.03) and at 6 months (F=4.2, p=.04) after intervention; (2) fewer number of TRB partners at 6 months after intervention (OR=2.7, 95% CI NR, p=.04); (3) fewer unprotected anal or vaginal sex acts with any sex partners at 6 months after intervention (F=7.7, p=.01); (4) greater proportion of condom use during anal or vaginal sex with any partners at 6 months after intervention (F=3.8, p=.05). No significant effect on the proportion of condom use during anal or vaginal sex with non-HIV-positive partners at 3 months (p=.60) and 6 months (p=.23) after intervention. |
| EBI | Kalichman et al.[45], 2005–2009, S | None (436) | RCT, Attention control | Integrated Risk Reduction and Adherence Intervention (7/12), Group | Sex outcome Significant positive intervention effects on TRB: fewer TRB at 1.5 months after intervention (Mean=0.9 [SD=5.3] vs. Mean=2.3 [SD=15.0], p <.05) and at 4.5 months after intervention (Mean=0.2 [SD=1.0] vs. Mean=1.0 [SD=3.8], p<.05). No significant effect on the number of TRB sex partners over the assessment points (p=.1). |
| EBI | McKirnan et al. [54], 2004–2006, MW | MSM (313) | RCT, Standard of care | Treatment Advocacy Program (4/9), Individual | Sex outcome Significant positive intervention effects on TRB: (1) decrease in the percentage of participants reporting any TRB across the 12-month assessment period (χ2 (2, N=249)=6.59, p=.037), from baseline to 4 months post-intervention (χ2 (1, N=249)= 6.57, p=.01), and from baseline to the mean of 4 and 10 months post-intervention (χ2 (1, N=249)=5.47, p=.019); (2) decrease in the mean number of TRB sex partners across the 12-month assessment period (χ2 (2, N=249)=7.16, p = .008), from baseline to 4 months post-intervention (χ2 (1, N=249)=7.01, p = .008), and from baseline to the mean of 4 and 10 months post-intervention (χ2 (1, N=249)= 6.3, p=.012). |
| EBI | NIMH et al. [31], 2000–2004, NE, MW, W | Engaged in HIV transmission risk behavior (936) | RCT, Waitlist | Healthy Living Project (15/22.5), Individual | Sex outcome Significant positive intervention effects on TRB: greater reduction in the mean number of unprotected anal or vaginal TRB from 5–25 months post baseline (χ2=27.8, df=5; p<.0001) and 20 months post baseline (8 months after intervention) (p=.0014). |
| EBI | Richardson et al. [59], 1998–2001, W | HIV clinic patients (886) | RCT, Attention control | Partnership for Health (3–5 minutes each clinic visit), Individual | Sex outcome Significant positive intervention effects: less likely to report unprotected anal or vaginal sex at 1 to 7 months among those who had 2 or more sex partners at baseline (OR=0.42, 95% CI=0.19 to 0.91, p=.03), among men who have sex with men with 2 more sex partners at baseline (OR=0.43, 95% CI=0.19 to 0.94, p=.04), and among those who had any casual or exchange partners at baseline (OR=0.51, 95% CI=0.27 to 0.95, p=.04). No significant effect among those who had only main partners at baseline (OR=1.31, 95% CI=0.67, 2.57, p=.44) |
| EBI | Rotheram-Borus et al. [62], 1994–1996, W, NE, S | HIV+ youth (310) | Non-RCT, Standard of care | Teens Linked to Care (31/62), Group | Sex outcome Significant positive intervention effects on TRB and other outcomes at 3 months after Act Safe intervention module: (1) lower mean percentage of unprotected anal or vaginal TRB (2.8% vs. 15.5%, p < .05); (2) more likely to report no sex or 100% condom use (80% vs. 67%, p<.01). No significant effect on the number of sex partners (0.2 vs. 0.2, p value NR). |
| EBI | Rotheram-Borus et al. [63], 1999–2003, W, NE | Young substance abusers (175) | RCT, Waitlist | Choosing Life: Empowerment, Actions, Results (CLEAR) (18/36), Individual | Sex outcome Significant positive intervention effects on TRB and other outcomes at 15 months post baseline: Increased proportion of protected acts with all sex partners (58% vs. 22%, p<.01) and with HIV-negative partners (73% vs. 32%, p <.01). No significant effect on 100% condom use or abstinent (58% vs. 59%, p value NR). Drug outcome No significant effect on the percentage of participants injected drugs (11% vs. 20%, p value NR). |
| EBI | Sikkema et al. [67], 2002–2005, NE | With childhood sexual abuse history (247) | RCT, HIV demand control | LIFT (15/22.5) Group | Sex outcome Significant positive intervention effects on TRB and other outcomes across 4-, 8-, and 12-month assessments: fewer unprotected anal or vaginal sex acts with all partners (β=−0.233; F(1,540)=131.61; p<.001)and with HIV-negative and unknown serostatus partners (β=−0.315; F(1,221)=57.22; p<.001). |
| EBI | Wingood et al. [74], 1997–2002, S | Sexually active HIV+ female clinic patients (391) | RCT, Attention control | WILLOW (4/16), Group | Sex outcome Significant positive intervention effects: (1) fewer unprotected vaginal sex acts at 6 months (mean difference= −.05, p=.037) and at 12 months (mean difference= −1.3, p=.029) after intervention; (2) less likely to report never using condoms at 6 months (OR=0.3, 95% CI=0.7 to 0.9), p=.043) and 12 months (OR=0.2, 95% CI=0.5 to 0.8, p=.026) after intervention. Biologic outcome Significant positive intervention effect: less likely to acquire new bacterial STDs (chlamydia and gonorrhea) over the 12 month period (OR=0.2, 95% CI=0.1 to 0.6, p=.006). |
| EBI | Wolitski et al. [75], 2000–2002, NE, W | MSM who engaged in HIV transmission risk behavior (811) | RCT, HIV demand control | Summit Enhanced Peer- Led (6/18), Group | Sex outcome Significant positive intervention effects on TRB: less likely to report unprotected receptive anal TRB at 3 months after intervention (OR =0.65, 95% CI=0.44, 0.97, p<.05). No significant effect on unprotected insertive TRB (OR =0.74, 95% CI=0.48, 1.16). Biologic outcome No significant effect: STDs (syphilis, gonorrhea, chlamydia, and herpes simplex virus 1 and 2) at 6 months after intervention (test results and p value NR) |
| Rigorous Non-EBI | Holstad et al. [42], 2005–2008, S | Women (203) | RCT, Attention control | Group Motivational Interviewing (8/16), Group | Sex outcome No significant effects: (1) abstinence, (2) use of condom during anal, oral, or vaginal sex during the assessment periods (baseline, 2 weeks, 3 months, 6 months, and 9 months)(test results and p values NR). |
| Rigorous Non-EBI | Illa et al. [43], 2004–2007, S | Sexually active older clinic patients (241) | RCT, HIV demand control | Project ROADMAP (4/6), Group | Sex outcome No significant effects on TRB and other outcomes: inconsistent condom use at 6 months post baseline with the following type of partners: (1) any sex partners (7% vs. 8%, p value NR); (2) TRB partners (1.3% vs. 3%, p value NR); (3) HIV-positive partners (5% vs. 6.5%, p value NR). |
| Rigorous Non-EBI | Metsch et al. [55], 2001–2003, S, W | Recently diagnosed (316) | RCT, Standard of care | ARTAS - Antiretroviral Treatment Access Study (5/NR), Individual | Sex outcome No significant effects on TRB: unprotected anal or vaginal TRB over 12 months (OR=0.96, 95% CI=0.62 to 1.50, p=.865). |
| Rigorous Non-EBI | Purcell et al. [58], 2001–2004, NE, S, W | Injection drug users (966) | RCT, HIV demand control | INSPIRE (10/20), Group | Sex outcome No significant effects on TRB: unprotected anal or vaginal TRB at (1) 3 months after intervention (OR=1.22, 95% CI=0.79, 1.89); (2) 6 months after intervention (OR=1.32, 95% CI=0.83, 2.12); (2)12 months after intervention (OR=1.01, 95% CI=0.63, 1.61). Drug outcome No significant effects on lending a needle or sharing drug paraphernalia with HIV-negative or serostatus unknown partners at (1) 3 months after intervention (OR=0.78, 95% CI=0.49, 1.25); (2) 6 months after intervention (OR=0.68, 95% CI=0.40, 1.13); (2)12 months after intervention (OR=0.77, 95% CI=0.42, 1.41). |
| Rigorous Non-EBI | Safren et al. [64], 2004–2008, NE | MSM who engaged in HIV transmission risk behavior (201) | RCT, Standard of care | Project Enhance (5/7.5 plus 4 boosters), Individual | Sex outcome No significant effects on TRB: unprotected insertive or receptive anal TRB over time (baseline, 3, 6, 9 and 12 months)(OR=0.94, 95% CI=0.78 to 1.16). |
| Rigorous Non-EBI | Sorensen et al. [69], 1994–1998, W | Out of treatment substance abusers (190) | RCT, HIV demand control | Case Management (ongoing), Individual | Sex outcome No significant effect on sex risk behaviors at 6 months after intervention (OR=0.97, 95% CI=0.54 to 1.74)b. Drug outcome No significant effect on needle-sharing behavior at 6 months after intervention (OR=0.63, 95% CI=0.35 to 1.13)b. |
| Rigorous Non-EBI | Rosser et al. [61], 2005–2007, NE, S, W | MSM who engaged in HIV transmission risk behavior (675) | RCT, HIV demand control | Positive Connections (1/16), Group | Sex outcome No significant effects on TRB: unprotected anal TRB, condition by time (baseline, 6, 12, and 18 months after intervention)(test results and p values NR). |
| Rigorous Non-EBI | Velasquez et al. [71], 1999–2003, NR | MSM with alcohol abuse (253) | RCT, HIV demand control | Motivational Interviewing (8/NR), Group | Sex outcome No significant effects on the number of unprotected-sex days from baseline to 12 months (χ2=2.92, df=8; p=.94)a. |
| Rigorous Non-EBI | Williams et al. [73], NR, NR | Heterosexual African American crack smokers (347) | RCT, Attention control | Positive Choices (6/6), Group | Sex outcome No significant effects on consistent condom use during vaginal sex, condition by time (baseline, 3 and 9 months)(F=0.61, df NR, p=.43). |
| Rigorous Non-EBI | Wolitski et al. [76], 2004–2007, MW, S, W | Homeless or at severe risk of homelessness (644) | RCT, HIV demand control | Housing Assistance & HIV Prevention (case management + 2 HIV sessions/1.25), Individual | Sex outcome No significant effects on TRB and other outcomes: (1) unprotected anal or vaginal TRB, condition by time (baseline, 6, 12, and 18 months)(F=0.28, df NR, p=.84), (2) the number of partners, condition by time (baseline, 6, 12, and 18 months)(F=1.01, df NR, p=.39). |
| Positive Non-EBI | Chen et al. [30], 2005–2007, MW, NE, S, W | Youth with medication adherence, substance abuse or sexual risk problems (142) | RCT, Standard of care | Healthy Choices (4/6), Individual | Sex outcome Significant positive intervention effects from baseline to 15-month assessment: (1) increased odds of persistent low sex risk (0–2 times no condom use during study period, OR=2.71, 95% CI=1.33 to 5.52, p <.01); (2) reduced odds of high sex risk (10 or more times no condom use during study period, OR=0.41, 95% CI=0.17 to 0.99, p<.05). |
| Positive Non-EBI | Coates et al. [33], NR, W | Gay men (64) | RCT, Waitlist | Stress Reduction Training (9/NR), Group | Sex outcome Significant positive intervention effect on the number of sex partners at post intervention (mean difference=1.20, 95%CI=0.14 to 2.28, p value NR). |
| Positive Non-EBI | Cosio et al. [35], 2007–2008, MW, NE, S, W | Rural & engaged in HIV transmission risk behavior (79) | RCT, HIV demand control | Telephone Motivational Interviewing (2/NR), Individual | Sex outcome Significant positive intervention effect on the mean percentage of vaginal sex partners with whom condoms were used all the time at 2 months after intervention (27.1% vs. 22.5%, F=(1,77)=3.2, p<.05). No significant effect on the mean percentage of anal sex partners with whom condoms were used all the time at 2 months after intervention (20.1% vs. 19.4%, F value NR, p=.35). |
| Positive Non-EBI | Grinstead et al. [41], 1996–1998, W | Male prison inmates (123) | Non-RCT, Waitlist | Health Promotion (8/20), Group | Sex outcome No significant effect on the percentage condom use at first sex since release (OR, 0.57; 95% CI, 0.18–1.80)b. Drug outcome Significant positive intervention effect: Among injectors, less likely to report needle sharing at post-release (OR=0.11; 95% CI=0.03 to 0.41)b. No significant effect on the percentage of participants injected drugs since release (48% vs. 48%, p value NR). |
| Positive Non-EBI | Lightfoot et al. [48], 2001–2006, W | HIV clinic patients (529) | RCT, Waitlist | MD4 LIFE computer- delivered (11/2), Individual | Sex outcome Significant positive intervention effects on TRB over the 30-month post baseline period: (1) decreased the number of TRB partners (t=2.34, df=1952, P= 0.02); (2) decreased the number of unprotected anal or vaginal TRB (t= 3.23, P< 0.01). |
| Positive Non-EBI | Lovejoy et al. [49], 2009–2010, NE, MW, S | Older adults who engaged in HIV transmission risk behavior (100) | RCT, Standard of care | Telephone- delivered Motivational Interviewing (4/3), Individual | Sex outcome Significant positive intervention effects: the fewer number of unprotected anal or vaginal sex at 3 months (OR=0.32, 95% CI=0.17 to 0.56)b and 6 months (OR=0.37, 95% CI=0.2 to 0.69)b after intervention. |
| Positive Non-EBI | Margolin et al. [50], 1997–2001, NE | Injection drug users in methadone maintenance treatment (90) | RCT, HIV demand control | HHRP+ (48/minimum of 96), Group | Sex and drug outcomes Significant positive intervention effect: less likely to engage in either unprotected sex or needle sharing or needle sharing 3 months after intervention (OR=2.96, 95% CI=1.05 to 8.36, p<.04). |
| Positive Non-EBI | Mausbach et al. [52], 1999–2005, W | Meth-using MSM who engaged in HIV transmission risk behavior (341) | RCT, Attention control | EDGE (8/12), Individual | Sex outcome Significant positive intervention effects: a greater (log) number of anal, oral and vaginal sex protected by a condom or oral dam at 5 months after intervention/8 months post baseline (t=2.13, df=283, p=.034) and at 9 months after intervention/12 months post baseline (t=2.72, df=480, p=.007). No significant effects: (1) (log) number of unprotected anal, oral, or vaginal sex (test results and p value NR); (2) ratio of total protected-to-total sex acts (test results and p value NR). |
| Positive Non-EBI | McCoy et al. [53], 1990–1992, S | Injection drug users (140) | RCT, Standard of care | Case Management Services (on- going), Individual | Sex outcome No significant effect on the number of sex partner (multiple R=.15, p value NR) and use of condoms (multiple R=.38, p value NR) at 6 months after baseline. Drug outcome Significant intervention effect on the number of injecting partners at 6 months after baseline (multiple R=.62, p<.01) No significant effect on injecting heroin and cocaine at 6 months after baseline (multiple R=.40, p value NR). |
| Positive Non-EBI | Petry et al. [57], 2003–2008, NE | Patients with cocaine or opioid use disorders (170) | RCT, Attention control | Contingency Management (24/24), Group | Sex and drug outcomes Significant positive intervention effects: reduced scores on the HIV Risk Behavior Scale, including risky sex and drug use behaviors, between baseline and 6 months (F(1,133)=4.75, p<.05) and baseline and 12 months (F(1,139)=5.23, p<.05). |
| Positive Non-EBI | Rose et al. [59], 2004–2006, W | HIV clinic patients who engaged in HIV transmission risk behavior(386) | RCT, Standard of care | HIV Intervention for Provider (ongoing), Individual | Sex outcome Significant positive intervention effects: reduced the number of sex partners (OR=0.49, 95% CI=0.26 to 0.92, p<.03) at 6 months post baseline. No significant effects on TRB: (1) the number of TRB partners (OR=0.93, 95% CI=0.82, 1.69, p=.86); (2) unprotected anal or vaginal TRB(OR=1.44, 95% CI=0.90 to 2.30, p=.42). |
| Positive Non-EBI | Teti et al. [70], 2004–2008, NE | Women (184) | RCT, HIV demand control | Protect and Respect (5/7.5), Group | Sex outcome Significant positive intervention effects: (1) greater odds of reporting condom use during anal or vaginal sex at 6 months (OR=17.13, 95% CI=2.96, 99.10, p<.01) and at 18 months (OR=270.04, 95% CI=24.53 to 2971.94, p<.01) post baseline. |
| Positive Non-EBI | Wyatt et al. [77], NR, W | Women with histories of childhood sexual abuse (147) | RCT, HIV demand control | Enhance Sexual Health Intervention (11/1.5), Group | Sex outcome Significant positive intervention effects: greater percentage of participants reporting vaginal sex protected by condom (OR=2.96, 95% CI NR, p=.039, one-tailed). |
| Other Non-EBI | Cleary et al. [32], 1986–1989, NE | Recently diagnosed blood donors (271) | RCT, Standard of care | Cognitive Behavioral and Skills Training Support Group (6/9), Group | Sex outcome No significant effect on the percentage of participants reporting unprotected sex at 10.5 months after intervention (30.9% vs. 37.7%, p value NR) |
| Other Non-EBI | Coleman et al. [34], 2006–2007, NE | Older African American MSM (60) | RCT, Attention control | Social Cognitive (4/8), Group | Sex outcome No significant effects at 3 months after intervention: (1) reported consistent condom use (OR=2.04, 95% CI=0.48 to 8.77, p=.336); (2) had multiple sex partners (OR=1.43, 95% CI=0.35 to 5.79, p=.062). |
| Other Non-EBI | Fogarty et al. [38], 1993–1996, S | Women (322) | RCT, Standard of care | Women and Infants Demonstration Project (1– 24/NR), Group | Sex outcome No significant effects: (1) the odds of progressing in use of condoms with main male partner at 6–12 months (OR=1.95, p=.19) and at 12–18 months (OR=2.13, p=.13) post baseline; (2) the odds of relapsing in use of condoms with main male partner at 6–12 months (OR=0.38, p=.10) and at 12–18 months (OR=0.47, p=.15) post baseline. |
| Other Non-EBI | Kelly et al. [46], 1991, MW | Depressed Men (115) | RCT, Standard of care | Support Group (8/12), Group | Sex outcome No significant effect on the mean number of unprotected insertive anal sex acts at 3 months after intervention (OR=0.92; 95% CI= 0.35 to 2.45, p value NR)b. |
| Other Non-EBI | Lapinski et al. [47], NR, MW | MSM (72) | Non-RCT, HIV demand control | Prevention Options for Positives (6/9), Group | Sex outcome No significant effect on the mean score of risk reduction index at 6 weeks after intervention (1.45 vs. 1.23, p value NR). |
| Other Non-EBI | Margolin et al. [51], NR, NE | Injection drug users in methadone maintenance treatment (38) | Non-RCT, Standard of care | 3-S+ for HIV+ drug users (12/NR), Group | Sex and drug outcomes No significant effect on the mean score of the Risk Assessment Battery assessing a range of drug- and sex-related HIV risk behaviors after intervention (0.03 vs. 0.03, p value NR). |
| Other Non-EBI | Patterson et al. [56], 1996–2001, W | Engaged in HIV transmission risk behavior (387) | RCT, Attention control | Share Safer Sex (3/4.5), Individual | Sex outcome Significant negative intervention effect on TRB at 8 months after intervention: intervention group reporting more unprotected anal, oral, and vaginal TRB (test result and p value NR). No significant effect on TRB at 12 months after intervention: the mean number of unprotected anal, oral, and vaginal TRB (OR=0.66; 95% CI=0.33 to1.33)b. Biologic outcome No significant effect on the mean number of STDs (not defined) across 12 months after intervention (test results and p value NR). |
| Other Non-EBI | Schwarcz et al. [65], 2006–2010, W | MSM engaged in HIV transmission risk behavior (411) | RCT, HIV demand control | Personalized Cognitive Counseling (2/2), Individual | Sex outcome No significant effect on TRB: (1) mean number of unprotected anal TRB at the 12-month assessment (6 months after intervention; incident rate ratio: 0.48, 95%CI=0.12, 1.84, p=.34), (2) percentage of participants reporting unprotected anal TRB at 6 months after intervention (27.8% vs. 22.3%, p value NR). Biologic outcome No significant effect on the lab confirmed diagnosis of STD (gonorrhea or Chlamydia; test results and p value NR). |
| Other Non-EBI | Serovich et al. [66], 2005–2006, MW | MSM (77) | RCT, Waitlist | HIV-related Disclosure (4/5), Group | Sex outcome Statistically significant negative intervention effect: intervention group had a greater odds of unprotected insertive anal sex at 3 months after intervention (OR=2.54, 95%CI NR, p<.05). No significant effect on the odds of unprotected receptive anal sex at 2 months after intervention (OR=1.55, 95% CI and p value NR). |
| Other Non-EBI | Sikkema et al. [68], 2006–2008, NE | Newly diagnosed bisexual/gay men in care (65) | RCT, Standard of care | Positive Choices (3/3), Individual | Sex outcome No significant effects at 3 months after intervention/6 months post baseline: (1) unprotected anal or vaginal sex acts with any partners (OR=0.54, 95% CI=0.21 to 1.38)b; (2) the number of sex partners (OR=0.72, 95% CI=0.28 to 1.82)b. Biologic outcome No significant effect on STDs symptoms (not defined) at 3 months after intervention (24.1% vs. 28.6%, p value NR) |
| Other Non-EBI | Williams et al. [72], 2003–2006, W | African American, Latino MSM (137) | RCT, Attention control | Sexual Health Intervention for Men (S- HIM) (6/12), Group | Sex outcome No significant effects: (1) the score of sex risk behavior scale, including oral, anal or vaginal sex (F (3, 130)=1.15, p=.33, condition by time interaction), (2) the number of sex partners (F(3, 129)<1, p value NR, condition by time interaction). |
Category: EBI = evidence-based interventions that show at least one significant positive intervention effect and have low risk of bias in study design, implementation and analysis; Rigorous Non-EBI = interventions show no significant positive intervention effects but have low risk of bias; Positive non-EBI = interventions show at least one significant positive intervention effect but have high risk of bias; Other non-EBI = interventions show no significant positive intervention effect and have high risk of bias
Region: NE=northeast, MW=midwest, S=south, W=west
NR=not reported
TRB = HIV transmission risk behavior defined as unprotected sex with HIV-negative or serostatus unknown partners
aadditional info obtained from authors;
Full article at: http://goo.gl/IjK4vC
By:
aPrevention Research Branch, Division of
HIV/AIDS Prevention, The U.S. Centers for Disease Control and Prevention
bICF International, Inc
Correspondence to: Nicole Crepaz, PhD, The U.S. Centers for
Disease Control and Prevention, Division of HIV/AIDS Prevention, Prevention
Research Branch, 1600 Clifton Rd., Mailstop E-37, Atlanta, Georgia, 30333, USA,
Phone: 1-404-639-6149, Fax: 1-404-639-1950,vog.cdc@zapercn
More at: https://twitter.com/hiv_insight
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