Written clinic procedures enhance delivery of HIV "prevention with positives" counseling in primary health care settings.
BACKGROUND
The Institute of Medicine recommends prevention counseling in primary health care settings to help HIV-infected individuals reduce the risk of transmitting HIV to others ("prevention with positives"). In this study, we assessed receipt of HIV prevention counseling by patients seen in clinics funded by the Ryan White CARE Act, a major source of support for HIV primary care.


METHODS
Six hundred fourteen HIV-infected patients completed an exit survey immediately after an HIV primary care visit at 16 clinics in 9 states. Patient characteristics and frequency of receipt of HIV prevention counseling were measured. Clinic approaches to HIV prevention were coded as clinics with written procedures, clinics where individual providers initiated counseling because of a personal sense of responsibility, and clinics with no procedures.


RESULTS
HIV-infected patients in clinics with written procedures were significantly more likely to report receiving HIV prevention counseling in the last 6 months than were patients in clinics with no procedures (odds ratio [OR] = 3.17, 95% confidence interval [CI]:1.24-8.06; P < 0.02). In clinics where individual providers initiated counseling and in clinics with no procedures, patient characteristics such as race, gender, and sexual orientation were associated with receipt of prevention counseling. These differences were not observed in clinics with written procedures, however.


CONCLUSIONS
Written procedures provide an important guide for clinic staff and increase the likelihood that patients receive prevention with positives counseling irrespective of patient characteristics.
Myers
Janet J
JJ
Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, CA 94105, USA.
Steward
Wayne T
WT
Charlebois
Edwin
E
Koester
Kimberly A
KA
Maiorana
Andre
A
Morin
Stephen F
SF
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001727:Bisexuality; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000534:rehabilitation / Q000635:transmission; D006306:Health Surveys; D006716:Homosexuality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010353:Patient Education as Topic / Q000379:methods; D011320:Primary Health Care