Efficacy of a “One-Shot” Computerized, Individualized Intervention to Increase Condom Use and Decrease STDs among Clinic Patients with Main Partners Diane M. Grimley, PhD Lucy Annang, PhD

Special Acknowledgement Jeffrey M. Bellis, PhD Co-Principal Investigator

Introduction The STD clinic evaluation visit may be the only opportunity providers have to promote risk reduction behaviors. Prevention efforts are often difficult to emphasize in settings delivering STD care: –Time constraints –Differing priorities about the use of clinical time

To assist busy clinicians with prevention efforts we developed and implemented an interactive ACASI system that was programmed to: – assess individuals’ condom use behavior – determine their readiness for change – provide individualized feedback

Department of Health Behavior School of Public Health UAB

Specific Aims 1.To increase consistent condom use among patients with main partners. 2. To decrease the rates of STDs (GC and CT) among patients with main partners.

Study Design 5-year study funded by NIH: NIAID Randomized controlled trial Assessments at baseline and 6 months post intervention

Target Population Low-income, predominately African American males and females seeking care at the Jefferson County Department of Health (JCDH) STD Clinic

Recruitment Procedure Individuals seeking an evaluation visit were recruited in the clinic waiting area by trained project staff –Provided an overview of study and invited to participate –Informed consent was obtained –Computer randomized patients by gender to one of two conditions

Intervention Group A theory-based, interactive, multimedia, computer-based intervention –Assessment plus individualized feedback Underlying conceptual framework –Transtheoretical model of change –Social cognitive theory –Two paths based on sexual orientation

Control Group An ACASI multiple health risk assessment (MHRA) examining: –Health care seeking behavior –Sexual risk behaviors –Condom use –Substance use (smoking, alcohol, and drug use) –Birth control use –Violence

Additional Data Collected Clinical data –Baseline visit GC & CT test results (chart reviews)

Overall Recruitment Rate Recruitment ended April ,848 participants enrolled –93% recruitment rate

Follow-up Selection Process Computer randomly selected a subsample of 625 patients (by gender and stage of change) to return in 6-months (post intervention) 580 agreed to come back (93%) Of these, 430 reported having a main partner and had complete data.

Overview of the Population

Intervention and Comparison Conditions at Enrollment Characteristic Intervention (n=203) Comparison (n=227) P-value Age (mean yrs ± sd) ± ± Gender Male Female 40.2 (82) 59.8 (121) 45.8 (104) 54.2 (123) 0.22 Race/Eth African Am. White Other 90.4 (184) 7.5 (15) 1.7 (4) 87.7 (199) 10.1 (23) 2.2 (5) 0.55

Intervention and Comparison Conditions at Enrollment Characteristic Intervention (n=203) Comparison (n=227) P-value Education < H.S. H.S./GED Some college/ degree 29.0 (59) 51.0 (104) 20.0 (40) 34.9 (79) 50.0 (113) 15.1 (34) 0.39 Single Yes 87.4 (177) 89.9 (204) 0.47 Repeater to the clinic Yes 68.2 (139) 74.4 (169) 0.14

Intervention and Comparison Conditions at Enrollment Characteristic Intervention (n=203) Comparison (n=227) P-value Age of sexual initiation (mean yrs ± sd) 14.9 ± ± Number of partners (lifetime) or more 30.3 (62) 68.7 (141) 28.9 (61) 72.7 (165) 0.33 Number of partners (past yr.) < 3 > (121) 40.5 (82) 61.2 (139) 38.8 (88) 0.69

Intervention and Comparison Conditions at Enrollment CharacteristicIntervention (n=239) Comparison (n=227) P-value Condom used last sexual encounter? No 67.0 (159) 61.0 (147) 0.61 History of STDs Yes 60.1 (140) 28.9 (61) 0.33

Follow-up: Assessing Consistent Condom Use and STDs (GC & CT) 6-months post intervention Return rate: 78% in the treatment group (n=158/203) 58% in the comparison group (n=132/227)

Follow-up (cont.) Self-administered paper-and-pencil assessment on current condom use with their main partner Provided urine sample for LCR screening of chlamydia and gonorrhea

Results Consistent Condom Use ___________________________________ Baseline 6-months _______________________________________________ Intervention ControlIntervention Control 14.5% 19.8% 21.0% 13.3% p=0.25 p=0.03 _______________________________________________

Results (cont.) STDs Rates (GC & CT) __________________________________ Baseline 6-months ________________________________________________ Intervention Control 28.0% 23.9% 11.7% 14.4% p>0.05 p>0.05 Difference of proportions 16.3% 9.5% p=.0358 ________________________________________________

Conclusion This “one-shot” theory-based intervention showed modest, but statistically significant, changes in consistent condom use and rates of chlamydia and gonorrhea at 6 months post-intervention.

Implications Potentially cost- effective computerized interventions based on a patient’s readiness for change would benefit STD clinic patients if they were integrated into the routine evaluation visit.