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JAMA. 2013 Oct 23;310(16):1701-10. doi: 10.1001/jama.2013.280034.

Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial.

Author information

1
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York2Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.

Abstract

IMPORTANCE:

To increase human immunodeficiency virus (HIV) testing rates, many institutions and jurisdictions have revised policies to make the testing process rapid, simple, and routine. A major issue for testing scale-up efforts is the effectiveness of HIV risk-reduction counseling, which has historically been an integral part of the HIV testing process.

OBJECTIVE:

To assess the effect of brief patient-centered risk-reduction counseling at the time of a rapid HIV test on the subsequent acquisition of sexually transmitted infections (STIs).

DESIGN, SETTING, AND PARTICIPANTS:

From April to December 2010, Project AWARE randomized 5012 patients from 9 sexually transmitted disease (STD) clinics in the United States to receive either brief patient-centered HIV risk-reduction counseling with a rapid HIV test or the rapid HIV test with information only. Participants were assessed for multiple STIs at both baseline and 6-month follow-up.

INTERVENTIONS:

Participants randomized to counseling received individual patient-centered risk-reduction counseling based on an evidence-based model. The core elements included a focus on the patient's specific HIV/STI risk behavior and negotiation of realistic and achievable risk-reduction steps. All participants received a rapid HIV test.

MAIN OUTCOMES AND MEASURES:

The prespecified outcome was a composite end point of cumulative incidence of any of the measured STIs over 6 months. All participants were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum (syphilis), herpes simplex virus 2, and HIV. Women were also tested for Trichomonas vaginalis.

RESULTS:

There was no significant difference in 6-month composite STI incidence by study group (adjusted risk ratio, 1.12; 95% CI, 0.94-1.33). There were 250 of 2039 incident cases (12.3%) in the counseling group and 226 of 2032 (11.1%) in the information-only group.

CONCLUSION AND RELEVANCE:

Risk-reduction counseling in conjunction with a rapid HIV test did not significantly affect STI acquisition among STD clinic patients, suggesting no added benefit from brief patient-centered risk-reduction counseling.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT01154296.

PMID:
24150466
PMCID:
PMC4110051
DOI:
10.1001/jama.2013.280034
[Indexed for MEDLINE]
Free PMC Article

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