title: Multicentre RCT and economic evaluation of a psychological intervention together with a leaflet to reduce risk behaviour amongst men who have sex with men (MSM) prescribed post-exposure prophylaxis for HIV following sexual exposure (PEPSE): a protocol.
abstract: BACKGROUND
  Post-exposure prophylaxis (PEP) following sexual exposure to HIV has been recommended as a method of preventing HIV infection in the UK. Men who have sex with men (MSM) are the group most affected by HIV in the UK and their sexual risk taking behaviour is reported to be increasing. One-to-one behavioural interventions, such as motivational interviewing (MI) have been recommended to reduce HIV in high risk groups. The Information, Motivation and Behavioral skills (IMB) model has been shown to provide a good basis for understanding and predicting HIV-relevant health behaviour and health behaviour change, however the IMB has yet to be applied to PEP after risky sexual exposure. The primary aim of this trial is to examine the impact of MI augmented with information provision and behavioural skills building (informed by the IMB Model), over and above usual care, on risky sexual behaviour in MSM prescribed PEP after potential sexual exposure. A secondary aim of this research is to examine the impact of the intervention on adherence to PEP. This study will also provide estimates of the cost-effectiveness of the intervention.
  
  
  METHODS
  A manualised parallel group randomised controlled trial with economic evaluation will be conducted. The primary outcome is the proportion of risky sexual practices. Secondary outcomes include: i) Levels of adherence to PEP treatment; ii) Number of subsequent courses of PEP; iii) Levels of motivation to avoid risky sexual behaviours; iv) Levels of HIV risk-reduction information/knowledge; v) Levels of risk reduction behavioural skills; vi) Diagnosis of anal gonorrhoea, Chlamydia and/or HIV. 250 participants will be asked to self-complete a questionnaire at four time points during the study (at 0,3,6,12 months). The intervention will consist of a two-session, fixed duration, telephone administered augmented MI intervention based on the IMB model. A newly developed treatment manual will guide the selection of persuasive communication strategies as appropriate for each participant and will be based on underlying change mechanisms specified by the IMB theoretical framework. Information provision and skills building will also be included in the intervention package through the use of information leaflets and tailored action plans. Fidelity of intervention delivery will be assessed.
  
  
  CONCLUSIONS
  The results from this NIHR funded study will identify whether it is appropriate and cost-effective to intervene using one-to-one telephone calls with MSM seeking PEP. If the intervention is effective, further work will be needed on training staff to deliver the intervention competently.
  
  
  BACKGROUND
  UKCRN ID:11436; ISRCTN00746242.
authors.affiliation: Brighton & Sussex Medical School, Brighton, UK. c.d.llewellyn@bsms.ac.uk
authors.forename: Carrie
authors.initials: C
authors.lastname: Llewellyn
authors.forename: Charles
authors.initials: C
authors.lastname: Abraham
authors.forename: Alec
authors.initials: A
authors.lastname: Miners
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
authors.forename: Alex
authors.initials: A
authors.lastname: Pollard
authors.forename: Paul
authors.initials: P
authors.lastname: Benn
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
mesh_terms: D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004501:Education, Medical / Q000191:economics / Q000379:methods*; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D056990:Post-Exposure Prophylaxis / Q000191:economics / Q000379:methods*; D012309:Risk-Taking; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult