title: Implementation and Operational Research: Computer-Assisted Intervention for Safer Sex in HIV-Positive Men Having Sex With Men: Findings of a European Randomized Multi-Center Trial.
abstract: OBJECTIVE
  Men who have sex with men (MSM) are the key population most affected by HIV in Europe. We performed the first European multicenter, simple-randomized parallel-group study to test the effectiveness of a theory-guided computer-assisted intervention to improve safer sex among HIV-positive men who have sex with men.
  
  
  METHODS
  Between February, 2011 and February, 2013, 112 participants were enrolled in 8 different European HIV-care settings. Intervention participants received 3 individual counseling sessions facilitated by trained service providers using computer-assisted tools. The control-group received sexual health advice delivered as part of regular HIV care. Outcome behavior (self-reported condom use at last intercourse; combined HIV transmission risk score), its influencing factors, and mediating variables were assessed at baseline, and at 3 and 6 months follow-up. Mixed effects models were used to compare primary outcomes (condom use at last intercourse, HIV transmission risk score), and mediation analysis to explore intervention effects.
  
  
  RESULTS
  Condom use at last intercourse increased more among intervention than control participants at 3 months follow-up (odds ratio of 3.83; P = 0.03), but not significantly at 6 months follow-up. Intervention participants reported a lower transmission risk at 3 months follow-up than controls (odds ratio compared with baseline of 11.53 and 1.28, respectively; P = 0.008), but this effect became nonsignificant at 6 months. Intervention effects were mediated by the proximal variables, self-efficacy to negotiate condom use and condom attitudes.
  
  
  CONCLUSIONS
  This intervention showed short-term effectiveness. The intervention should be replicated in other settings, eventually investigating if booster-counseling sessions would yield a longer lasting effect.
authors: Departments of *Public Health; †Clinical Sciences, Institute of Tropical Medicine, ITM's HIV AIDS Center (IHAC), Antwerp, Belgium; ‡Department of Infectious Diseases, Ludwig-Maximilian University, University Hospital Munich, Munich, Germany; §Faculty of Education, Sociology, and Health Services, University of Zielona Gora, Zielona Gora, Poland; ‖Institute of Tropical Medicine and Hygiene, Lisbon, Portugal; ¶Central North West London NHS Trust, London, United Kingdom; #Department of Medicine, Center for Infectious Diseases and Travel Medicine and IFB Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany; **AIDES, Mission Innovation Recherche Expérimentation (MIRE), Paris, France; ††National Reference Centre for HIV/AIDS Prevention, Slovak Medical University, Bratislava, Slovak Republic; ‡‡Faculty of Psychology and Educational Sciences, Open University, Heerlen, the Netherlands; and §§Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
authors: Christiana
authors: C
authors: Nöstlinger
authors: Tom
authors: T
authors: Platteau
authors: Johannes
authors: J
authors: Bogner
authors: Jozefien
authors: J
authors: Buyze
authors: Joanna
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authors: Dec-Pietrowska
authors: Sonia
authors: S
authors: Dias
authors: John
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authors: Newbury-Helps
authors: Agnes
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authors: Kocsis
authors: Matthias
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authors: Mueller
authors: Daniela
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authors: Rojas
authors: Danica
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authors: Stanekova
authors: Jacques
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authors: van Lankveld
authors: Robert
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authors: Colebunders
mesh_terms: D000328:Adult; D003194:Computer-Assisted Instruction / Q000379:methods / Q000592:standards; D017280:Condoms / Q000706:statistics & numerical data; D003376:Counseling / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D021841:Safe Sex; D011795:Surveys and Questionnaires; D019562:Viral Load