154132 Positive Choice: A "video doctor" intervention reduces risky behaviors by HIV-positive adults

Monday, November 5, 2007: 8:30 AM

Paul A. Gilbert, MSPH , Center for Health Improvement and Prevention Studies, University of California San Francisco, San Francisco, CA
Daniel Ciccarone, MD, MPH , Family and Community Medicine, University of California San Francisco, San Francisco, CA
Stuart A. Gansky, MS, DrPH , Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, CA
Sophia H. Calderon, BA , Center for Health Improvement and Prevention Studies, University of California San Francisco, San Francisco, CA
Barbara Gerbert, PhD , Center for Health Improvement and Prevention Studies, University of California San Francisco, San Francisco, CA
                    
Background: Improved HIV treatments have decreased mortality and changed patterns of morbidity. Accordingly, prevention strategies have shifted to recognize the role of HIV-positive persons. Practice guidelines now recommend that HIV care providers screen and counsel their patients about behavioral risks, but consistent implementation of these guidelines is rare.

Methods: We developed the Positive Choice computer program to improve screening and counseling about substance use and unprotected sex by HIV-positive adults. Positive Choice consisted of computerized risk-assessment followed by an interactive and engaging “video doctor,” simulating an ideal conversation with a health care provider. We tested its effectiveness in a randomized, controlled trial at five outpatient HIV clinics in the San Francisco Bay Area.

Results: Between December 2003 and February 2006, 918 patients completed a baseline risk assessment; 497 (54%) reported one or more risky behaviors; over 80% completed six-month follow-ups. Fewer intervention than control participants reported unprotected sex with casual partners at 3-month follow-up (OR 0.313, 95% CI: 0.102, 0.950); any drug use at both 3- and 6-month follow-ups (OR 0.356, 95% CI: 0.180, 0.703; and OR 0.207, 95% CI: 0.101, 0.424); methamphetamine use at both 3- and 6-month follow-ups (OR 0.285, 95% CI: 0.097, 0.841; and OR 0.344, 95% CI: 0.128, 0.922); and heavy drinking at 3-month follow-up (OR 0.310, 95% CI: 0.119, 0.808).

Conclusions: Positive Choice achieved significant reductions in drug use, including methamphetamine, and some reductions in heavy drinking and unprotected sex. Positive Choice is an efficacious and appropriate adjunct to risk-reduction efforts in HIV care.

Learning Objectives:
1. Analyze the current practice guidelines for “prevention with positives” as a part of routine HIV care. 2. Demonstrate the use of multimedia technology, including the interactive “video doctor,” to overcome barriers to routine screening and counseling about risky behaviors. 3. Identify the behavior change results achieved by the Positive Choice intervention.

Keywords: Behavioral Research, Risk Assessment

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Innovative HIV Interventions among Vulnerable Populations
See more of: HIV/AIDS