The Treatment Advocacy Program: A Randomized Controlled Trial of a Peer-Led Safer Sex Intervention for HIV-Infected Men Who Have Sex with Men

Objective: Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a 4-session, primar...

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Bibliographic Details
Published in:Journal of consulting and clinical psychology 2010-12, Vol.78 (6), p.952-963
Main Authors: McKirnan, David J, Tolou-Shams, Marina, Courtenay-Quirk, Cari
Format: Article
Language:English
Subjects:
Acquired Immunodeficiency Syndrome (AIDS)
Advocacy
Advocacy services
AIDS Prevention
Behavior therapy. Cognitive therapy
Biological and medical sciences
Counseling Effectiveness
Disease Control
Efficacy
Health Knowledge, Attitudes, Practice
HIV
HIV Infections - psychology
HIV Infections - transmission
HIV Seropositivity - psychology
Homosexuality
Homosexuality, Male - psychology
Homosexuals
Human
Humans
Intervention
Male
Males
Medical sciences
Men - psychology
Mental health
Peer Counseling
Peer Group
Peer Groups
Prevention. Health policy. Planification
Primary Health Care
Program Evaluation
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Risk
Risk Reduction Behavior
Risk-Taking
Safe Sex
Safe Sex - psychology
Safety
Same Sex Intercourse
Sexual Partners - psychology
Sexually Transmitted Diseases
Social psychiatry. Ethnopsychiatry
Treatment Effectiveness Evaluation
Treatments
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Summary:Objective: Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a 4-session, primary-care-based, individual counseling intervention led by HIV-positive MSM "peer advocates" in reducing unprotected sex with HIV-negative or unknown partners (HIV transmission risk). Method: We randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6 months, and 12 months (251 participants completed all study waves). We conducted intent-to-treat analyses using general estimating equations to test the interaction of group (TAP vs. standard care) by follow-up period. Results: At study completion, TAP participants reported greater transmission risk reduction than did those receiving standard care, [chi][squared](2, N = 249) = 6.6, p = 0.04. Transmission risk among TAP participants decreased from 34% at baseline to about 20% at both 6 and 12 months: Transmission risk ranged from 23% to 25% among comparison participants. Conclusions: TAP reduced transmission risk among HIV-positive MSM, although results are modest. Many participants and peer advocates commented favorably on the computer structure of the program. We feel that the key elements of TAP--computer-based and individually tailored session content, delivered by peers, in the primary care setting--warrant further exploration. (Contains 2 tables, 1 footnote and 4 figures.)
ISSN:0022-006X
1939-2117
DOI:10.1037/a0020759