title: HERMITAGE--a randomized controlled trial to reduce sexually transmitted infections and HIV risk behaviors among HIV-infected Russian drinkers.
abstract: OBJECTIVE
  This study assessed the effectiveness of HERMITAGE (HIV's Evolution in Russia-Mitigating Infection Transmission and Alcoholism in a Growing Epidemic), an adapted secondary HIV prevention intervention, compared with an attention control condition in decreasing sexually transmitted infections (STIs) and sex and drug risk behaviors among Russian HIV-infected heavy drinkers.
  
  
  METHODS
  We conducted a single-blinded, two-armed, randomized controlled trial with 12-month follow-up.
  
  
  METHODS
  The study was conducted in St Petersburg, Russia. Participants were recruited from four HIV and addiction clinical sites. The intervention was conducted at Botkin Infectious Disease Hospital.
  
  
  METHODS
  HIV-infected individuals with past 6-month risky sex and heavy alcohol consumption (n = 700) were randomized to the HERMITAGE intervention (n = 350) or an attention control condition (n = 350).
  
  
  METHODS
  A Healthy Relationships Intervention stressing disclosure of HIV serostatus and condom use, adapted for a Russian clinical setting with two individual sessions and three small group sessions.
  
  
  METHODS
  The primary outcome was incident STI by laboratory test at 12-month follow-up. Secondary outcomes included change in unprotected sex and several alcohol and injection drug use (IDU) variables.
  
  
  RESULTS
  Participants had the following baseline characteristics: 59.3% male, mean age 30.1, 60.4% past year IDU, 15.4% prevalent STI and mean CD4 cell count 413.3/μl. Assessment occurred among 75 and 71% of participants at 6 and 12 months, respectively. STIs occurred in 20 subjects (8.1%) in the intervention group and 28 subjects (12.0%) in the control group at 12-month follow-up; logistic regression analyses found no significant difference between groups (adjusted odds ratio 0.63; 95% confidence interval = 0.34-1.18; P = 0.15). Both groups decreased unsafe behaviors, although no significant differences were found between groups.
  
  
  CONCLUSIONS
  The HERMITAGE HIV risk reduction intervention does not appear to reduce sexually transmitted infections and HIV risk behaviors in Russian HIV-infected heavy drinkers compared with attention controls.
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Elena
authors.initials: E
authors.lastname: Blokhina
authors.forename: Carly
authors.initials: C
authors.lastname: Bridden
authors.forename: Christine E
authors.initials: CE
authors.lastname: Chaisson
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Walley
authors.forename: Tibor P
authors.initials: TP
authors.lastname: Palfai
authors.forename: Emily K
authors.initials: EK
authors.lastname: Quinn
authors.forename: Edwin
authors.initials: E
authors.lastname: Zvartau
authors.forename: Dmitry
authors.initials: D
authors.lastname: Lioznov
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000379:methods; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012426:Russia / Q000453:epidemiology; D055502:Secondary Prevention; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D016037:Single-Blind Method; D016896:Treatment Outcome; D047568:Unsafe Sex
keywords: HIV risk behaviors; Healthy relationships; RCT; Russian HIV; STI; substance users