# Presentation: 266181

## Experience with HIV/STD Prevention Counseling with a Rapid HIV Test and Counseling Quality Assurance (RESPECT-2) 

- <footer>

***Experience with HIV/STD Prevention Counseling with a Rapid HIV Test and Counseling Quality Assurance (RESPECT-2)***

- M Iatesta1; B Dillon1; _S Padilla__2_,
- L Brooks3; L Raveneau4; C Metcalf1 and the RESPECT-2 Study Group

- 1Centers for Disease Control and Prevention, Atlanta, GA; 2California State University, Long Beach, CA; 3Denver Public Health, Denver, CO; 4North Jersey Community Research Initiative, Newark, NJ

## Multi-center randomized controlled trial of HIV testing and counseling interventions for STD prevention 
Participants randomized to either:(1) Standard HIV testing and 2 counseling sessions 1 to 2 weeks apart; or (2) Rapid HIV testing and 2 counseling sessions at the same visit 
Followed-up for 1 year with STD screening & questionnaire every 3 months 

- Participants randomized to either:(1) Standard HIV testing and 2 counseling sessions 1 to 2 weeks apart; or (2) Rapid HIV testing and 2 counseling sessions at the same visit
- Followed-up for 1 year with STD screening & questionnaire every 3 months

*Background*

## To describe the RESPECT-2 protocol for prevention counseling with a rapid HIV test 

To describe methods used in the RESPECT-2 study to assure quality prevention counseling 

- To describe methods used in the RESPECT-2 study to assure quality prevention counseling

*Objectives*

## Structured protocols with multiple components 
Use of open-ended questions 
Suggested questions for each component as a guide 
Data-gathering and routine use of informational messages discouraged 
Focus on specific risk circumstances, risk pattern and risk triggers and vulnerabilities

- Use of open-ended questions
- Suggested questions for each component as a guide
- Data-gathering and routine use of informational messages discouraged
- Focus on specific risk circumstances, risk pattern and risk triggers and vulnerabilities

*Prevention Counseling Protocols General Principles *

## Positive reinforcement of past and intended efforts at risk reduction
Identification & discussion of conflicts between client's concern about HIV risk, and risky behavior (dissonance)
Stepwise reduction of risk in small achievable steps
Client-specific risk-reduction plan

- Identification & discussion of conflicts between client's concern about HIV risk, and risky behavior (dissonance)
- Stepwise reduction of risk in small achievable steps
- Client-specific risk-reduction plan

*Prevention Counseling Protocols General Principles **(continued)*

## Initial Session (10-18 minutes) 
Introduction and orientation 
Enhancement of client’s self-perception of risk 
Exploration of the specifics of the most recent risk incident 
Review of previous risk-reduction experiences 
Synthesis of risk incident and risk pattern 
Results Session (10-21 minutes) 
Provision of HIV test results 
Negotiation of a risk-reduction plan 
Identification of sources of support & provision of referrals (if indicated)

- Introduction and orientation
- Enhancement of client’s self-perception of risk
- Exploration of the specifics of the most recent risk incident
- Review of previous risk-reduction experiences
- Synthesis of risk incident and risk pattern
**Results Session (10-21 minutes)**
- Provision of HIV test results
- Negotiation of a risk-reduction plan
- Identification of sources of support & provision of referrals (if indicated)

*Single Visit (Rapid Test) Prevention Counseling Protocol*

## Need to explain rapid test procedure and the meaning of results. (Preliminary positive results need confirmation) 
Need to focus the client if distracted by the prospect of receiving his/her HIV result the same visit as the HIV test 
Greater emphasis on use of referrals and social support to enhance risk-reduction

- Need to focus the client if distracted by the prospect of receiving his/her HIV result the same visit as the HIV test
- Greater emphasis on use of referrals and social support to enhance risk-reduction

*How Single Visit Protocol Differs from Standard 2-visit Protocol*

## Single-visit HIV counseling protocol is acceptable to counselors and clients 

Efficacy relative to the standard 2-visit prevention counseling protocol will not be known until the end of the study 

- Efficacy relative to the standard 2-visit prevention counseling protocol will not be known until the end of the study

*Observations - Single Visit Prevention Counseling Protocol*

## Objective is to ensure that counselors adhere to study counseling protocols and do quality counseling  

Counseling QA is a routine ongoing activity 

Approximately 15% of counseling sessions are observed by a trained supervisor or taped and reviewed later 

- Counseling QA is a routine ongoing activity
- Approximately 15% of counseling sessions are observed by a trained supervisor or taped and reviewed later

*Methods - Counseling Quality Assurance (QA)** *

## Structured QA forms are used to assess adherence to counseling protocols 

Counselors & supervisor do group tape reviews during routine case conferences

Counselors are given ongoing feedback & mentoring to improve adherence to protocols & counseling skills 

- Counselors & supervisor do group tape reviews during routine case conferences
- Counselors are given ongoing feedback & mentoring to improve adherence to protocols & counseling skills

*Methods - Counseling Quality Assurance (QA)** **(continued)*

## Able to provide immediate feedback to the counselor 

Able to observe the counselor’s non-verbal communication including counselor’s body language, eye contact and demeanor

Experience the complexity of the interpersonal dynamics between the client and the counselor

- Able to observe the counselor’s non-verbal communication including counselor’s body language, eye contact and demeanor
- Experience the complexity of the interpersonal dynamics between the client and the counselor

*Advantages of In-Person Observation**** ***

## More flexibility in timing of review 

Able to replay parts of session for clarification 

Able to use taped sessions as a training tool 

Opportunity to track improvement in counseling skills 

- Able to replay parts of session for clarification
- Able to use taped sessions as a training tool
- Opportunity to track improvement in counseling skills

*Advantages of Taping**** ***

## Approximately 80% of participants approached have agreed to have counseling taped
Initial counselor reluctance & discomfort overcome once familiar with counseling QA as an ongoing & routine activity 
Counselors respond positively to feedback
Group review of tapes promotes discussions of alternative ways to approach sessions & enhance risk-reduction plans
A structured counseling QA protocol is useful to ensure that essential components of the session are consistently addressed and enhance the quality of the counseling

- Initial counselor reluctance & discomfort overcome once familiar with counseling QA as an ongoing & routine activity
- Counselors respond positively to feedback
- Group review of tapes promotes discussions of alternative ways to approach sessions & enhance risk-reduction plans
- A structured counseling QA protocol is useful to ensure that essential components of the session are consistently addressed and enhance the quality of the counseling

*Observations - Counseling QA*

## Study Group

- Long Beach:  Kevin Malotte, Suzanne Padilla, Nettie DeAugustine, David Souleles, Judy Hollingshead, Erin Griffin, Christine Heusner
- Denver:  John Douglas, Lesley Brooks, Ken Miller, Cornelis Rietmeijer, Mark Foster
- Newark:  Sindy Paul, Helene Cross, Lena Raveneau, LaVerne Parish
- CDC:  Carol Metcalf, Tom Peterman, Michael Iatesta, Beth Dillon, Mary Kamb, Vel McKleroy Beena Varghese, Laura Selman, Heather Frederick
- NOVA Research: Paul Young, Carmita Signes, Chris Gordon, Robert Francis Jr.
- CAIR:  Seth Kalichman