Enhancing primary care HIV prevention: A comprehensive clinical intervention

• Published in: American journal of preventive medicine 2001-04, Vol.20 (3), p.177-183
• Main Authors: Dodge, Wayne T, BlueSpruce, June, Grothaus, Louis, Rebolledo, Viviana, McAfee, Timothy A, Carey, James W, Thompson, Robert S
• Format: Article
• Language: English
• Subjects: Adult; condoms; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Health Maintenance Organizations; Health Surveys; HIV infections; HIV Infections - prevention & control; HIV Infections - transmission; Humans; Male; managed care programs; Middle Aged; Outcome and Process Assessment (Health Care); Patient Care Team; Patient Education as Topic; Primary Health Care; primary prevention; risk assessment; sexually transmitted diseases; Sexually Transmitted Diseases - prevention & control; Sexually Transmitted Diseases - transmission
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/S0749-3797(00)00308-1

Context: Human immunodeficiency virus (HIV) and sexually transmitted disease (STD) risk assessment and counseling are recommended for a large proportion of the population, yet measured rates of such counseling remain low. Objective: Use a comprehensive intervention to improve and sustain rates of HIV/STD risk assessment and counseling by providers. Design: Patient telephone survey using a one-group pre- and post-intervention design with measurements over a 62-week period. Setting and Participants: Patients (N=1042) from two outpatient clinics at a health maintenance organization (HMO) presenting for either of two types of index visit: symptomatic ( n=210), or routine physical examination or birth control ( n=832) visits. Main Outcome Measures: Telephone survey performed within 3 weeks of the index visit. Patients’ recall of a general discussion of HIV/STDs and specific discussion of sexual behaviors/risk factors. Results: The intervention was associated with increased patient recall of providers: discussing HIV/STD in general (OR 1.6; 95% CI, 1.12–2.22), asking about sexual behaviors/risk factors (OR 1.7; 95% CI, 1.2–2.6), discussing HIV prevention generally (OR 2.4; 95% CI, 1.4–4.0), and discussing personal risk reduction (OR 2.6; 95% CI, 1.6–4.3). Provision of written materials concerning HIV/STD also increased significantly (OR 2.8; 95% CI, 1.3–4.3). A clear-cut pattern of improved provider effort was seen, with the most pronounced improvements in high-risk patients. Results were stable over a 38-week follow-up period. Conclusion: A sustained improvement in HIV/STD risk assessment and counseling can be achieved in an outpatient HMO setting using a relatively non-intensive systematized intervention.