Effectiveness of HIV/Sexually Transmitted Infection Training for Physicians in China
Condition: HIV Infections; Gonorrhea; Chlamydia
MeSH terms: Infections; Gonorrhea
Study type: Interventional

Summary: 
      This study will evaluate the effectiveness of a physician training program, the Ai Shi Zi
      program, in improving HIV/sexually transmitted infection diagnosis, treatment, and management
      by Chinese physicians and in reducing the number of subsequent infections in their patients.
    

Detailed description: 
      HIV and sexually transmitted infections (STIs) are among the foremost public health concerns
      worldwide, with the number of infections continuing to rise significantly. Specifically, in
      China, the number of cases of HIV is estimated to rise from 650,000 in 2006 to more than 10
      million by the year 2010. The reasons for the drastic increase may be associated with a lack
      of education about proper condom use and consequences of sexual risk behaviors and the
      existing stigma toward HIV/STI patients. Therefore, increased knowledge of HIV/STI prevention
      and treatment is necessary for both physicians and patients in China. A program that provides
      training in HIV/STI prevention, treatment, and management to physicians may be an effective
      means of enhancing their abilities to deliver high quality, integrated HIV/STI prevention and
      treatment. The Ai Shi Zi program, which provides training on stigma, risk-reduction
      counseling methods, and treatment skills to county and township level physicians in China,
      may be an effective means of implementing HIV/STI training. This study will evaluate the
      effectiveness of the Ai Shi Zi program in improving HIV/STI diagnosis, treatment, and
      management by Chinese physicians and in reducing the number of subsequent HIV/STI infections
      in their patients.

      Participants in this study will include county level physicians and their patients and
      township level physicians. All physicians will first undergo baseline assessments that will
      include questions about knowledge of HIV/STI, capability of administering HIV/STI screening
      and risk-reduction counseling, and attitudes toward working with HIV/STI-infected
      individuals. Physicians will then be assigned randomly to receive the Ai Shi Zi program or no
      training.

      Physician training in the Ai Shi Zi program will consist of multiple components: an
      orientation workshop on fundamental knowledge and skills of HIV/STI treatment and prevention,
      a 3-month practice period, a 3-month post-practice seminar on preventive counseling, another
      3-month practice period, and a 6-month post-practice seminar on clinical HIV and STI
      management. Physicians will keep weekly journals during both 3-month practice periods, citing
      the most interesting or difficult STI or HIV case they experienced during the week. The
      practice periods will promote learning-by-doing to further enhance physicians' abilities to
      deliver high quality, integrated HIV/STI prevention and treatment. Both post-practice
      seminars will allow physicians to share experiences gained during the previous 3-month
      practice period. County level physicians will receive the seminar training from experts in
      the fields of HIV/STIs, behavioral counseling, and stigma reduction. After completing the
      first post-practice seminar, the county level physicians then, in turn, will present the
      training to the township level physicians. All physicians will undergo repeat baseline
      assessments at post-training; post-practice seminars; and Months 1, 2, and 15 after
      orientation.

      Upon completion of the 6-month post-practice seminar, physicians will begin to implement the
      Ai Shi Zi program in their clinics. Each patient participant who seeks treatment from
      physician participants, who have received either Ai Shi Zi training or no training, will
      first undergo a test for chlamydia and gonorrhea. On this initial visit, the physicians who
      have received the Ai Shi Zi program will provide HIV/STI risk-behavior counseling to their
      patients. The counseling will include discussion of topics such as partner notification,
      HIV/STI prevention, expected difficulties in changing behaviors, and development of a
      risk-reduction plan. Patient participants will then return within 2 weeks to receive their
      test results and additional behavioral counseling. If the STI is confirmed by the lab test,
      patients will be treated with standard care and will be asked to complete an assessment. The
      assessment will include a 30-minute interview about HIV/STI-related knowledge, attitudes,
      beliefs, practices, service utilization, and risk behaviors. Nine months after baseline,
      patient participants will undergo a repeat interview.
    

Intervention name(s): Physician Ai Shi Zi training; Standard care; Patient risk-reduction counseling
Intervention type(s): Behavioral; Drug; Behavioral
Intervention description(s): This training uses a curriculum developed specifically for Project Ai Shi Zi and includes training in stigma; risk-reduction counseling; and quality HIV/STI diagnosis, treatment, and management. Physician training will consist of multiple components: an orientation workshop on fundamental knowledge and skills of HIV/STI treatment and prevention, a 3-month practice period, a 3-month post-practice seminar on preventive counseling, another 3-month practice period, and a 6-month post-practice seminar on clinical HIV and STI management. The practice periods will promote learning-by-doing to further enhance physicians' abilities to deliver high quality, integrated HIV/STI prevention and treatment. Post-practice seminars will allow participants to share experiences gained during the previous 3-month practice period.; If an STI is confirmed by a lab test, participants will receive standard of care treatment. Gonorrhea will be treated with a single dose of 250 mg of ceftriaxone sodium administered by intramuscular injection. If patients are allergic to ceftriaxone, they will be treated with azithromycin (2 g single oral dose). Chlamydia will be treated with azithromycin (1 g single oral dose).; On the initial visit, participants will receive HIV/STI risk-behavior counseling from the physician trained in Ai Shi Zi. The process is based on motivational interviewing techniques and will include discussing topics such as partner notification, HIV/STI prevention, and expected difficulties in changing behaviors. This risk-reduction model encourages the HIV/STI-infected or -uninfected person to develop a risk-reduction plan. The objective is to decrease the chance of infection for that individual and for others, too. Patients will develop a list of risk-reduction strategies to follow.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Risk Reduction Counseling; Anhui, China; HIV; STI