Development and initial validation of a brief screener for focused HIV prevention efforts

Abstract

The public health response to the spread of HIV relies on behavioural changes, especially reductions in sexual and drug-use-related transmission risk behaviours (TRBs). While understanding the factors that dispose people towards risky behaviours is important scientifically, it can be difficult to distil the many predictors of sexual risk behaviours into a useful clinical tool for focused prevention efforts. Our goal was to evaluate the extent to which known predictors of sexual TRBs (self-efficacy, treatment optimism, engagement with medical care, awareness of risky behaviours, substance use, and relevant behavioural and socio-demographic characteristics) combined with additional attitude-related assessments to identify those who had engaged in recent sexual TRBs and may therefore be at risk of additional TRBs. In this study, we analysed data on beliefs and behaviours related to sex, substance use, HIV prevention and other relevant factors for 280 patients at a publicly funded HIV/AIDS clinic in Seattle. All participants completed a baseline audio computer-assisted self interview (ACASI) as part of a larger trial focused on reducing TRBs. Our multivariate model yielded three screening questions that could prove effective in identifying HIV-positive patients in need of focused prevention resources. The resulting screener holds promise as a brief and easily deployed tool that can be used by providers regardless of access to ACASI technology. Additional validation is needed and longitudinal evaluation is currently in progress.