Enhancing primary care HIV prevention - A comprehensive clinical intervention

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. Objectives: 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, 1.3-1.3). 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.