Abstract
ObjectiveDecreasing the risk of HIV transmission from HIV-positive individuals is an important public health priority. We evaluated the effectiveness of a computer-based sexual risk reduction counseling intervention (CARE+) among HIV-positive persons enrolled in care.MethodsHIV-positive eligible participants (N=1075) were enrolled from 11 care sites in the Bronx, NY and Washington, DC and randomized 1:1 to either a tablet-based self-administered CARE+ intervention or standard of care (SOC). The primary outcome was the proportion of participants reporting any unprotected vaginal/anal sex at last sex, among all partners, HIV-negative or HIV-unknown-status partners and for primary and non-primary partners.ResultsAt baseline, 7% of participants in both arms reported unprotected sex with an HIV-negative or HIV-unknown-status partner, while 13% in the CARE+ arm and 17% in the SOC arm reported unprotected sex with any partner. Most participants (88%) were on antiretroviral therapy (ART) at baseline. There was no significant difference in changes over time in unprotected vaginal/anal sex between the CARE+ and SOC arms for any partners (p=0.67) or either HIV-negative or HIV-unknown-status partners (p=0.40). At the Month 12 visit, most participants (85%) either strongly agreed or agreed that computer counseling would be a good addition to in-person counseling by a provider.ConclusionThe CARE+ intervention was not effective at reducing sexual risk behaviors among HIV-positive patients in care, most of whom were on ART. Further research may be warranted around the utility of computer-based counseling for HIV prevention.
Highlights
In the United States, there are more than 1.2 million persons living with HIV (PLWH), with an estimated 39,513 new diagnoses in 2015 [1]
There was no significant difference in changes over time in unprotected vaginal/anal sex between the CARE+ and standard of care (SOC) arms for any partners (p=0.67) or either HIV
The CARE+ intervention was not effective at reducing sexual risk behaviors among HIV-positive patients in care, most of whom were on antiretroviral therapy (ART)
Summary
In the United States, there are more than 1.2 million persons living with HIV (PLWH), with an estimated 39,513 new diagnoses in 2015 [1]. Most persons who are aware of their positive HIV status reduce risky sexual behaviors [2], for some PLWH, it may be difficult to achieve and sustain safer sexual behaviors [3,4,5] for numerous reasons. Some may believe that condom use reduces sexual pleasure while others may not have the confidence to consistently practice safer sex. Some PLWH may practice unsafe sex only with partners known to be HIV-positive, but the possibility of transmitting and acquiring different HIV strains still exists. While antiretroviral therapy (ART) can substantially reduce sexual HIV transmission [6,7], not all HIV-positive individuals in clinical care are effectively virally suppressed [8]. There is some evidence that “prevention for positives” (PfP) interventions effectively decrease risky sexual behaviors [9,10,11]
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