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Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
HIV-positive clinic patients
Goal of Intervention
Brief Description
Positive Choice is an
individual-level, interactive
computer-based intervention to improve
screening and counseling about ongoing
sex risk and substance use among
HIV-positive patients. While waiting for
the scheduled visit with a care
provider, HIV patients first complete
the Positive Choice risk assessment on a
laptop computer. Based on the risk
assessment, a video clip appears on the
computer in which an actor-portrayed
Video Doctor delivers interactive
risk-reduction messages to the patient.
The clip is matched and tailored to the
patient’s gender, risk profile, and
readiness to change. This risk-reduction
“Video Doctor” counseling session is
based on Motivational Interviewing
principles, which emphasize a
patient-centered approach,
non-judgmental tone, empathy, and
support. The Video Doctor counseling
session lasts an average of 24 minutes.
After this brief session, the computer
prints out two documents: (1) an
educational worksheet for participants
with questions for self-reflection, harm
reduction tips, and local resources; and
(2) a cuing sheet for health care
providers, which offers a summary of the
patient’s risk profile and readiness to
change, and suggested risk-reduction
counseling statements to serve as a
prompt for discussing risky behaviors
with patients. A booster Video Doctor
counseling session is provided 3 months
later and includes feedback reflecting
changes made since the initial visit,
along with an updated output for the
patient and provider to review and
discuss during the clinic visit. |
Theoretic Basis
- Motivational interviewing principles
Intervention Duration
One Video Doctor counseling session,
lasting 24-minutes on average; and 3
months later, one booster Video Doctor
counseling session, lasting about
24-minutes Intervention Setting
Outpatient HIV clinics
Deliverer
Actor-portrayed physician (computer program)
Delivery Methods
- Discussion
- Goal setting
- Printed materials
- Video-based counseling
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Intervention Package Information
An intervention package is not available
at this time. Please contact Barbara
Gerbert, PhD, Center for Health
Improvement and Prevention Studies
(CHIPS), University of California San
Francisco, 707 Parnassus Avenue, Box
0758, San Francisco, CA 94143-0758,
e-mail:
Barbara.gerbert@ucsf.edu, for
details on intervention materials.
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Evaluation Study and Results
The original evaluation study was conducted in San Francisco, California
between 2003 and 2006.
Key Intervention Effects
- Reduced unprotected sex
- Reduced number of casual sex
partners
Study Sample
The analytic study sample of 471
HIV-positive men and women is characterized
by the following:
- 50% African American, 29% White,
13% Hispanic, 8% Other
- 79% Male, 21% Female
- 51% MSM, 65% of men are MSM
- Mean age of 44 years
- 82% completed high school
education or more
Recruitment Settings
Outpatient HIV clinics located in public
hospitals, a community-based organization, a
private hospital, and a health maintenance
organization
Eligibility Criteria
HIV-positive clinic patients were eligible
if they were 18 years of age or older and
were HIV-positive for 3 months or longer.
Assignment Method
HIV-positive clinic patients (N = 476) were
randomly assigned to 1 of 2 groups: Positive
Choice (n = 243) or Usual Care comparison (n
= 233).
Comparison Group
The comparison group received the HIV
clinic’s usual care. Any risk assessment and
counseling for the comparison group was
dependent on the medical providers’ own
initiative and clinical judgment and was not
measured.
Relevant Outcomes Measured and Follow-up Time
Sex behaviors during past 3 months
(including any unprotected anal or vaginal
sex, condom use with main partner or casual
partner, and number of sex partners) were
measured at 3 and 6 months after the initial
Video Doctor counseling session. The 6-month
assessment was conducted 3 months after the
booster Video Doctor counseling session.
Participant Retention
- Positive Choice:
75% retained at 3 months after initial
Video Doctor counseling session
82% retained at 6 months (3 months after
booster Video Doctor counseling session)
- Usual Care:
81% retained at 3 months after
intervention
83% retained at 6 months (3 months after
booster Video Doctor counseling session)
Significant Findings
- Among HIV-positive clinic patients
who reported unprotected anal or vaginal
sex at baseline, intervention
participants were significantly less
likely than comparison participants to
report unprotected anal or vaginal sex
at 3 months after the initial Video
Doctor counseling session (p = .006) and
at 3 months after the booster Video
Doctor counseling session (p = .006).
- Intervention participants also
reported significantly fewer casual sex
partners than comparison participants at
3 months after the booster Video Doctor
counseling session (p = .042).
Considerations
- No significant intervention effect
was found for absolute percent change in
condom use with main partners or with
casual partners at either follow-up.
- Among HIV-positive clinic patients
who reported any drug use at baseline,
intervention participants were
significantly less likely than
comparison participants to report any
drug use at 3 months after the initial
Video Doctor counseling session (p =
.029) and at 3 months after the booster
Video Doctor counseling session (p <
.001).
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References and Contact Information
- Gilbert, P., Ciccarone, D., Gansky,
S. A., Bangsberg, D. R., Clanon, K.,
McPhee, S. J., et al. (2008).
Interactive “Video Doctor” counseling
reduces drug and sexual risk behaviors
among HIV-positive patients in diverse
outpatient settings. PLoS ONE, 3(4),
1-10.
Researcher: Barbara
Gerbert, PhD
Division of Behavioral
Science, Professionalism and
Ethics
707 Parnassus Avenue, Box
0758, University of California
San
Francisco, CA 94143
e-mail:
Barbara.gerbert@ucsf.edu
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Link to non-CDC Web site
