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The Research
The Intervention The Research
The Science Behind the Package
Partnership for Health (PfH) is a brief, provider-delivered, counseling
program for individual men
and women living with HIV/AIDS. The program is designed to improve patient-provider
communication about safer sex, disclosure of serostatus, and HIV prevention.
PfH is based on a
social cognitive model that uses message framing, repetition and reinforcement
to increase the
patient’s knowledge, skills, and motivations to practice safer sex.
Target
Population
HIV-positive men and women
Intervention
At clinics providing primary medical care to HIV-positive persons, patients
are given an
informational flyer (in English or Spanish) at the front desk. Posters calling
attention to the power
of patient-provider teamwork are displayed in the waiting room. After the
physical exam, the
medical provider conducts the 3- to 5-minute counseling session. The provider
delivers messages
that focus on self-protection, partner protection, and disclosure. The provider
frames the messages
relative to the number and type of sex partners the patient has and whether
the patient is practicing
safe or unsafe sex. Consequences-framed messages emphasize a positive outcome
that may be
missed or a negative result that may occur when the patient engages in unsafe
sexual behaviors or
does not disclose their serostatus to their partners. Advantages-framed messages
focus on a
positive outcome that may happen or a negative result that may be avoided
when the patient
engages in safe sexual behaviors or discloses their serostatus to partners.
The provider uses the
brochures, informational flyers and posters in the examination room to facilitate
counseling. The
provider and patient identify behavioral goals for the patient to work on.
The provider gives the
patient referrals to services if any are needed. At follow-up visits, the
provider inquires about the
patient’s progress on the behavioral goal, re-counsels the patient,
and reinforces the patient’s
healthful behavior.
Research Results
Patients who had 2 or more sex partners or at least 1 casual partner
and who received
consequences-framed messages were:
- Significantly less likely to engage in unprotected anal or vaginal
sex
For Details on the Research Design
Richardson J.L., Milam J., McCutchan A., Stoyanoff S., Bolan R., Weiss J.,
Kemper C., Larsen
R.A., Hollander H., Weismuller P., Chou C.P., and Marks G. Effect of brief
provider safer-sex
counseling of HIV-1 seropositive patients: A multi-clinic assessment. AIDS 2004;18:1179-1186.
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The Intervention
A Package Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated
project that identifies HIV/AIDS prevention
interventions with demonstrated evidence of effectiveness. REP supports the original
researchers in developing
a user-friendly package of materials designed for prevention providers. PfH is
one of the REP interventions and
is the product of extensive collaboration among researchers who originally developed
and evaluated the
intervention and the clinics and providers who implemented the intervention as
well as patient focus groups.
The package has been field tested in five clinics and one HIV prevention agency
by non-research staff.
Core Elements
Core elements are intervention components that must be maintained without
alteration to ensure program effectiveness. The core elements of Partnership for Health include:
- Having providers deliver the intervention to HIV-positive patients in HIV
outpatient clinics.
- Having the clinic adopt prevention as an essential component of patient
care.
- Training of all clinic staff
to facilitate integration of the prevention counseling intervention into
standard practice.
- Using waiting room posters and brochures to reinforce prevention messages
delivered by the provider.
- Building on the ongoing supportive relationship between the patient and
the provider.
- During routine visits, having
the provider initiate at least a 3- to 5-minute discussion with the patient
or client about safer sex that focuses on self-protection, partner protection,
and disclosure.
- Having the provider incorporate
good communication techniques and use of consequences-framed messages for
patients or clients engaged in high risk sexual behavior.
- Providing referrals for needs that require more extensive counseling and
services.
- Integrating the prevention message into clinic visits so that every patient
is counseled at every visit.
Package Contents
- A manual to guide clinics through planning, implementation, and maintenance
of the intervention.
- Sample brochures, chart stickers, pocket counseling outline, posters, and
flyers.
- A manual for each provider and a training video for each clinic
View
Package Contents | View Package Posters
Intervention Orientation
All clinic staff attend
a 4-hour training and a 1-hour booster session in which they learn how to
conduct the
intervention, practice intervention delivery skills, and identify agency-specific
implementation strategies.
Technical Assistance
Capacity-building assistance providers problem-solve with adopting agencies
to achieve an effective balance between maintaining core elements
and tailoring to local needs. Assistance providers address implementation
concerns, answer questions, and provide advice.
Timeline for Availability
The package will be available from CDC along with training on program
implementation and technical assistance in the future. The package
materials can be downloaded from
www.usc.edu/partnershipforhealth.
For More Information on
the Partnership for Health Package
Jean Richardson at the Keck School of Medicine, University of Southern California, Department of Preventive Medicine and Institute for Prevention Research, 1441 Eastlake Avenue, Suite 3409, Los Angeles, CA 90089-9175. Phone: 323-865-0343. E-mail:
jeanr@usc.edu. Or visit
www.usc.edu/partnershipforhealth.
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