Interactive “Video Doctor” Counseling Reduces Drug and Sexual Risk Behaviors among HIV-Positive Patients in Diverse Outpatient Settings

University of Cape Town, South Africa
PLoS ONE (Impact Factor: 3.23). 02/2008; 3(4):e1988. DOI: 10.1371/journal.pone.0001988
Source: PubMed


Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide “prevention with positives” in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors.

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Available from: Daniel H Ciccarone
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    • "Five randomized controlled trials with two parallel arms— The Healthy Living Project Team 2007, 3 Cornman 2008, 23 Gilbert 2008, 24 Kurth 2013, 25 Safren 2013, 26 comparing a behavioral intervention intended to reduce sexual risk behavior among PLWHA with no such intervention (standard care), met the review inclusion criteria. In the study by Gilbert, 24 risk counseling at providers discretion was allowed in the comparison group, yet no information on whether or "
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    ABSTRACT: Regular interactions with people living with HIV/AIDS (PLWHA) who are receiving care provide caregivers opportunities to deliver interventions to reduce HIV-related risks. We conducted a systematic review of behavioral interventions for PLWHA (provided at individual level by caregivers at HIV care settings) to determine their efficacy in reducing sexual risk behavior. Conference websites and biomedical literature databases were searched for studies from 1981 to 2013. Randomized and quasi-randomized controlled trials (with standard-of-care control groups), considering at least one of a list of HIV-related behavioral or biological outcomes in PLWHA aged ≥18 receiving HIV care with at least 3-month follow-up were included. No language or publication status restrictions were set. Standardized search, data abstraction, and evaluation methods were used. Five randomized controlled trials were included in the review. We found limited evidence that sexual risk reduction interventions increase condom use consistency in HIV transmission risk acts, and reduce the number of (casual) sexual partners. We still believe that regular interactions between HIV care providers and PLWHA provide valuable opportunities for theory-based sexual risk reduction interventions to restrain the spread of HIV.
    Full-text · Article · Apr 2015 · AIDS patient care and STDs
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    • "Five studies [31] [39] [40] [43] [45] compared computer-based PSMPs with a control intervention where no patient self-management "
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    ABSTRACT: OBJECTIVE: The aim of this systematic review is to investigate the effectiveness of using computers to deliver patient self-management programs (PSMPs) to patients with chronic illness in health supported settings. METHODS: We included randomized controlled trials (RCTs), where the experimental intervention was compared either with an equivalent 'standard' PSMP delivered by staff, usual care or no intervention and reported data either on clinical or behavioral outcomes. We conducted a narrative synthesis, incorporating a small quantitative analysis to enable comparisons across studies. RESULTS: A total of 11 studies met the inclusion criteria. There was insufficient evidence to determine whether computer-based PSMPs were superior to standard programs. However, it appeared that these interventions were effective when compared to no intervention. Interventions incorporating behavior change techniques beyond the provision of information appeared more effective than those that did not. CONCLUSION: Evidence from the current review, whilst limited, suggests that computer-based PSMPs, delivered in health-supported settings, show potential for changing health behaviors and improving clinical outcomes in patients with chronic illness. Practice Implications: Although the approach shows promise, it is premature to recommend the integration of these interventions into clinical practice. However, more well designed trials are warranted to test their efficacy and cost-benefit.
    Full-text · Article · Apr 2013 · Patient Education and Counseling
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    • "It is easy to understand (6th grade reading level) and uses an engaging multimedia format to convey the information . Script Safety consists of the following components: (1) assessment of demographics and opioid medication misuse risk factors (e.g., family history of addiction, previous prescription drug misuse behaviors); (2) pre-intervention assessment of knowledge regarding appropriate use, storage and disposal of prescription opiods; (3) interactive educational program including a " Video Doctor " consultation (Gilbert et al., 2008) reviewing the risks, and proper handling and disposal of the patient's specific opioid medication; (4) post-intervention assessment of knowledge to measure comprehension of material and provide immediate corrective feedback; and (5) a personalizable handout highlighting key learning points regarding the appropriate use, storage, and disposal of their opioid medication. "
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    ABSTRACT: Unlabelled: Prescription opioid misuse has been declared an American epidemic and a significant proportion of misused opioids are diverted from legitimate prescriptions. Patient education regarding appropriate use and the dangers of misuse has been identified as a key intervention target. The current study presents findings from the open pilot of a patient-tailored, brief, web-based intervention designed to improve knowledge of safe medication use, storage and disposal. Methods: Subjects were 62 treatment-seeking outpatients at two diverse outpatient health clinics (dental and pain management) who were prescribed an opioid medication. Subjects completed an online assessment of risk factors for prescription opioid misuse and the 15-minute Script Safety intervention. Knowledge and misuse behaviors were assessed at baseline, immediately post intervention (knowledge only) and at one-week and one-month follow up. Knowledge regarding safe prescription opioid use, storage and disposal improved significantly from pre to post intervention and was sustained at follow up (% correct from baseline to one-month follow up: unsafe to retain unused pills, 66.1% vs. 96.5%; unsafe to borrow pills from family/friends, 87.1% vs. 98.2%; best to store pills in cool, dry, secure location, 45.2% vs. 89.5%; not recommended to use expired medications, 75.8% vs. 96.5%; not recommended to flush all medications down the toilet, 45.2% vs. 82.5%, ps<.01). Reductions in self-reported misuse behaviors were also observed. Although preliminary, the findings highlight the potential utility of integrating brief, web-based educational interventions in community and primary health care settings.
    Full-text · Article · Feb 2013 · Addictive behaviors
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