Project enhance: a randomized controlled trial of a novel HIV prevention intervention for sexual risk-taking HIV-infected men who have sex with men conducted in a primary care setting

Published: July 22, 2010

Project enhance: a randomized controlled trial of a novel HIV prevention intervention for sexual risk-taking HIV-infected men who have sex with men conducted in a primary care setting

K. Mayer1,2, M. Skeer3,4, C. O’Cleirigh3,5, S. Safren3,5

1The Fenway Institute, Fenway Community Health, Boston, United States, 2Brown Medical School/Miriam Hospital, Infectious Diseaes, Providence, United States, 3Fenway Health, The Fenway Institute, Boston, United States, 4Brown University Alpert Medical School, Center for Alcohol and Addiction Studies, Providence, United States, 5Massachusetts General Hospital/Harvard Medical School, Psychiatry, Boston, United States

Background: Although more than half of the Americans living with HIV are men who have sex with men (MSM), there are few secondary prevention interventions for this population. Linking prevention with HIV care is an opportunity to efficiently identify and decrease HIV-transmission risk behavior in this population.
Methods: Two-hundred-and-one HIV-infected MSM who reported unprotected sex in the past 6-months were recruited in to the study in a Boston community health center. They were randomized to receive either treatment-as-usual or a prevention intervention based on the IMB model and delivered by medical social workers. The intervention involved four intervention sessions, three quarterly “booster” sessions, and proactive case management referrals for any unmet psychosocial needs. Demographic, sexual risk, and mental health data were collected at baseline and at 3, 6, 9 and 12-months. Treatment outcome and moderation analyses with depression were conducted using longitudinal negative binomial regressions.
Results: Over the course of the study, the risk of sero-discordant unprotected anal intercourse (SUAI) was significantly reduced among all participants (IRR: 0.88; 95% CI: 0.82-0.95; p< .0001). However, the reduction in SUAI was not significantly different between the intervention and control conditions (p=.846). Interestingly, depressed men in the intervention condition reported significant reductions in SUAI over the course of the study compared to depressed men in the control condition and non-depressed men in either the intervention or control conditions (p< .001).
Conclusions: Integrating HIV-prevention with clinical care for high-risk HIV-infected MSM was feasible and acceptable, but participants in both the intervention and control conditions experienced decreases in SUAI. Research designs are needed to delineate the contribution of specific intervention components vs. non-specific effects of study-related interviews and counseling on risk reduction. The exploratory analyses for moderated effects suggest that IMB interventions integrating prevention case management in primary care settings may be particularly beneficial for patients with co-occurring depression.

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