Clinician-initiated HIV risk reduction intervention for HIV-positive persons - Formative research, acceptability, and fidelity of the options project

Objective: To conduct research on levels and dynamics of HIV risk behavior among HIV-positive patients in clinical care, use this research to design a clinician-initiated HIV prevention intervention for HIV-positive patients, and evaluate the acceptability of the intervention to clinicians and patients and the fidelity with which it can be delivered by clinicians. Methods: Study 1 (elicitation research) involved focus groups with HIV-positive patients and HIV care clinicians to understand the dynamics of HIV risk behavior among HIV-positive patients and how to integrate HIV prevention into routine clinical care. Study 2 (acceptability and intervention fidelity) involved the evaluation of 1455 medical visits by experimental intervention patients (N = 231) for acceptability and fidelity of the clinician-initiated HIV prevention intervention. Results: Elicitation research with patients and clinicians identified critical HIV prevention information, motivation, and behavioral skills deficits in HIV-positive patients as well as risky sexual behavior. These findings were integrated into a theory-based HIV prevention intervention initiated by clinicians that proved acceptable to clinicians and patients and that clinicians were able to implement with adequate fidelity. Conclusion: HIV prevention interventions by clinicians treating HIV-positive patients can and should be integrated into routine clinical care.