Efficacy of adapted personalized cognitive counseling (PCC) for high-risk, HIV-negative, episodic substance-using MSM: Findings from project echo

Background: Episodic drug use and binge drinking are associated with sexual HIV risk behaviors among substance-using men who have sex with men (SUMSM), yet no evidence‐based HIV prevention interventions exist for these men. We adapted personalized cognitive counseling (PCC), addressing rationalizations for high-risk behavior, to SUMSM and evaluated the intervention. Methods: We conducted a randomized controlled trial (N=326) to test the efficacy of adapted PCC among HIV-negative, episodic SUMSM reporting recent UAI and concurrent use of methamphetamine, poppers, cocaine, or binge-drinking in the past 3 months. PCC participants (n=164) received HIV testing plus 2 counseling sessions; control participants (n=162) received HIV testing. Primary outcomes included number of UAI events, UAI partners, and UAI events with three most-recent non-primary partners. We examined linear trends in treatment effect using GEE Poisson models with robust standard errors and conducted sub-group analyses excluding 138 participants actually substance dependent at baseline. Results: Mean age was 33.6 years, 49% were white, 10% African American, 26% Latino; 96% completed 3 and 6 month follow-up. We observed parallel reductions in mean UAI events [PCC = 2.0 (4.7); control = 1.8 (4.4)], but no significant intervention effects in primary outcomes. For non-substance dependent men, UAI events with 3 most-recent non-primary partners declined among participants in PCC compared to control (RR=0.56, 0.34-0.92). Conclusion: We did not find evidence that adapted PCC was efficacious in reducing sexual risk behaviors in the overall sample, yet did observe a reduction in UAI events with recent partners among SUMSM not dependent on target substances.