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Interactive "Video Doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings.

ABSTRACT: BACKGROUND: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. METHODOLOGY AND FINDINGS:We conducted a parallel groups randomized controlled trial (December 2003-September 2006) at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults) completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476) were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a "Video Doctor" via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months) and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months). Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months) than did controls, and had fewer casual sex partners at (-2.3 vs. -1.4, p = 0.461, at 3 months; and -2.7 vs. -0.6, p = 0.042, at 6 months). CONCLUSIONS:The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level, and modest individual-level reductions in days of ongoing drug use and number of casual sex partners compared with the control group. Positive Choice, including Video Doctor counseling, is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient settings, and holds promise as a public health HIV intervention. TRIAL REGISTRATION:Clinicaltrials.gov NCT00447707.

SUBMITTER: Gilbert P

PROVIDER: S-EPMC2292251 | biostudies-literature | 2008 Apr

REPOSITORIES: biostudies-literature

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Interactive "Video Doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings.

Gilbert Paul P Ciccarone Daniel D Gansky Stuart A SA Bangsberg David R DR Clanon Kathleen K McPhee Stephen J SJ Calderón Sophia H SH Bogetz Alyssa A Gerbert Barbara B

PloS one 20080423 4

<h4>Background</h4>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- ...[more]

PMID: 18431475

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Project description:BackgroundDue to the hygiene measures during the coronavirus pandemic at the beginning of 2020, psychotherapy by personal attendance was no longer possible or only possible to a limited extent in many places in Germany. In its place, psychotherapy via video conference was used as an alternative option for treatment.ObjectiveThe present study was concerned with the question of the actual use of this form of psychotherapy during the lockdown.Material and methodsTherapists in the psychotherapeutic training outpatient department of the Medical School of Hanover were questioned on their experiences and the experiences of patients with the use of the video consultation during running guideline psychotherapy. Data from 338 patents could be collated. The data contained information, for example on acceptance or rejection of the offer of a video consultation, on the reasons for rejection and on technical problems by the execution.ResultsThe presented data show that 35% of patients could not be reached by the video consultation. Approximately half of the patients from this group could not use this form of therapy due to the lack of technical equipment. The other half did not want therapy using the video consultation, although the technical requirements were available. In the group of patients who used the video consultation, the session was interrupted due to technical disturbances in 31% of the cases. In a further 10% of the cases the disturbances even led to a premature termination of the session. The presented data make it clear that the use of therapy via video consultation significantly decreases with increasing age and reduced education level.ConclusionThe results of the present study show that a considerable proportion of the patients could not be reached by the offer, despite the dissemination of the video consultation; therefore, in the case of further lockdowns special offers for this group should be considered. The authors recommend that the health insurance companies provide support for patients who do not have the technical requirements at their disposal. Patients who do not want to participate in this form of treatment need therapeutically motivating support.

Project description:ContextThe objective of this systematic review was to update a prior review and summarize the evidence (newly identified and cumulative) on the impact of contraceptive counseling provided in clinical settings.Evidence acquisitionMultiple databases, including PubMed, were searched during 2016-2017 for articles published from March 1, 2011, to November 30, 2016.Evidence synthesisThe search strategy identified 24,953 articles; ten studies met inclusion criteria. Two of three new studies that examined contraceptive counseling interventions (i.e., enhanced models to standard of care) among adolescents and young adults found a statistically significant positive impact on at least one outcome of interest. Five of seven new studies that examined contraceptive counseling, in general, or specific counseling interventions or aspects of counseling (e.g., personalization) among adults or mixed populations (adults and adolescents) found a statistically significant positive impact on at least one outcome of interest. In combination with the initial review, six of nine studies among adolescents and young adults and 16 of 23 studies among adults or mixed populations found a statistically significant positive impact of counseling on at least one outcome of interest.ConclusionsOverall, evidence supports the utility of contraceptive counseling, in general, and specific interventions or aspects of counseling. Promising components of contraceptive counseling were identified. The following would strengthen the evidence base: improved documentation of counseling content and processes, increased attention to the relationships between client experiences and behavioral outcomes, and examining the comparative effectiveness of different counseling approaches to identify those that are most effective.Theme informationThis article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.

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Interactive "Video Doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings.

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Interactive "Video Doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings.

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