title: HIV prevention counseling intervention delivered during routine clinical care reduces HIV risk behavior in HIV-infected South Africans receiving antiretroviral therapy: the Izindlela Zokuphila/Options for Health randomized trial.
abstract: BACKGROUND
  Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression.
  
  
  OBJECTIVE
  To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART.
  
  
  METHODS
  Cluster-randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard of care.
  
  
  METHODS
  Publicly funded HIV clinical care sites.
  
  
  METHODS
  One thousand eight hundred ninety-one PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924).
  
  
  METHODS
  Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information-Motivation-Behavioral (IMB) Skills model during routine clinical care.
  
  
  METHODS
  Number of sexual events without a condom in the past 4 weeks with partners of any HIV status, and with partners perceived to be HIV negative or HIV-status unknown, assessed at baseline, 6, 12, and 18 months.
  
  
  RESULTS
  Intervention participants reported significantly greater reductions in HIV risk behavior on both primary outcomes, compared with standard-of-care participants. Differences in sexually transmitted infection incidence between arms were not observed.
  
  
  CONCLUSIONS
  Effective behavioral interventions, delivered by lay counselors within the clinical care setting, are consistent with the strategy of linking HIV care and HIV prevention and integrating biomedical and behavioral approaches to stemming the HIV epidemic.
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: *Department of Psychology, University of Connecticut, Storrs, CT; †Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT; ‡Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; §Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ‖Division of Research and Post-graduate Support, Durban University of Technology, Durban South Africa; ¶Enhancing Care Foundation, Durban University of Technology, Durban, South Africa; #Department of Health Behavior and Health Education, School of Public Health, University of Michigan; **AIDS Program, Section of Infectious Diseases, Departments of Medicine and Public Health, Yale School of Medicine, New Haven, CT; and ††Departments of Psychology and Obstetrics and Gynaecology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fisher
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Cornman
authors.forename: Paul A
authors.initials: PA
authors.lastname: Shuper
authors.forename: Sarah
authors.initials: S
authors.lastname: Christie
authors.forename: Sandy
authors.initials: S
authors.lastname: Pillay
authors.forename: Susan
authors.initials: S
authors.lastname: Macdonald
authors.forename: Ntombenhle
authors.initials: N
authors.lastname: Ngcobo
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
authors.forename: Umesh
authors.initials: U
authors.lastname: Lalloo
authors.forename: Gerald
authors.initials: G
authors.lastname: Friedland
authors.forename: William A
authors.initials: WA
authors.lastname: Fisher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003376:Counseling / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012725:Sexual Behavior; D013019:South Africa; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents