Paul Gilbert, MS¹, Barbara Gerbert, PhD¹, Dan Ciccarone, MD, MPH², Dale Danley, MPH¹, and Karen Herzig, PhD¹. (1) Center for Health Improvement and Prevention Studies, University of California San Francisco, 350 Parnassus Avenue #905, San Francisco, CA 94117, 415-502-7288, pgilbert@itsa.ucsf.edu, (2) Urban Health Study, Dept. of Family and Community Medicine, University of California, San Francisco, 3180 18th St. Suite 302, Campus Box 1304, San Francisco, CA 94110

Background: The CDC urges HIV health care providers to conduct in-depth risk assessments and brief interventions to help patients address risky behaviors. Computerized interventions can support and simplify providers’ role in “prevention for positives.” Our intervention seeks to protect the patient’s health and prevent HIV transmission to others.

Methods: We developed “Positive Choice,” a computer program employing both audio and video components to assess patients’ alcohol, drug, and sexual risk behaviors. Patients at-risk then participate in a discussion with a “video doctor” who delivers tailored risk-reduction messages, deployed from an extensive library of digital video clips, according to a complex branching structure. The messages, based on Motivational Interviewing principles, simulate a conversation with a real doctor. The program generates tailored worksheets for the patient and a cueing sheet for providers summarizing the patient’s risks and suggesting ways to continue the discussion. In December 2003 we began a randomized controlled trial of the program at two outpatient HIV primary care clinics.

Results: Initial baseline data show a high prevalence of risk behaviors within the last month, including anal or vaginal sex without a condom (43% of participants), drug use excluding marijuana (33%), and risky alcohol drinking (24%). Participants report high acceptability of the program (38% liked it; 62% liked it very much). Researchers are currently tracking 3- and 6-month behavior change outcomes for participants.

Conclusions: The Positive Choice program is a feasible adjunct to standard care for HIV-positive patients. Innovative technology can support and simplify providers’ efforts in “prevention for positives.”

Learning Objectives:

• Describe the components of a multimedia brief motivational intervention for HIV-positive patients.
• Recognize how innovative technology can support and simplify health care providers’ efforts to protect the patient’s own health while preventing HIV transmission to others.
• Describe the prevalence of key risky behaviors (alcohol use, drug use, risky sex) in the sample of Positive Choice participants.

Keywords: HIV/AIDS, Risky Behaviors

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.