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C omputer- A ssisted R isk assessment & E ducation: ‘ CARE ’ for HIV/STI

C omputer- A ssisted R isk assessment & E ducation: ‘ CARE ’ for HIV/STI. Development team : Resources Online (Jim Larkin; Seattle) A. Kurth, F. Spielberg (Univ. of Washington) J.D. Fortenberry (Indiana Univ.) C.K. Malotte, S. Padilla (Calif. State Long Beach)

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C omputer- A ssisted R isk assessment & E ducation: ‘ CARE ’ for HIV/STI

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  1. Computer-Assisted Risk assessment & Education: ‘CARE’ for HIV/STI Development team: • Resources Online(Jim Larkin; Seattle) • A. Kurth, F. Spielberg(Univ. of Washington) • J.D. Fortenberry(Indiana Univ.) • C.K. Malotte, S. Padilla(Calif. State Long Beach) • J. St. Lawrence,M. McFarlane (CDC)

  2. Why Provide HIV/STD Risk Assessment and Counseling? > 200,000 people in US, & millions globally, are unaware of their HIV+ status Proven models of brief HIV/STI health behavior change counseling Many sites do not have staff to deliver evidence-based HIV/STI prevention counseling

  3. How are we doing? • Missed Opportunity < 1/3 MDs routinely screen for STDs(St.Lawrence, et al. ‘02) 70% MDs believe counseling ineffective (Ashton et al., ‘02) • Barriers Lack of time, tools, $; pt risk assumptions, provider discomfort , clinician beliefs (benefits, negative pt reactions, time constraints)? (Montano et al ‘02) • Yet clients want to talk(Bennett et al ‘99) • Clients willing to disclose sex, drug risks when asked(Gerbert et al. ‘99)

  4. Health Behavior Change Model • Interactive, responsive to client • Heighten risk perception • Support prior behavior change attempts • Identify/develop client goals • Negotiate realistic detailed plan (Project Respect, Kamb ‘98)

  5. What’s Needed? An Interactive HIV/STD Computer Counseling Tool • Standardization of risk assessment and counseling. • More disclosure with ACASI format - feasible among low literacy populations • Allows clinics to provide HIV/STD testing when providers unavailable or makes counseling more efficient. • Allows outreach organizations to provide HIV/STD testing services when staff turn-over out-paces available counseling training.

  6. CARE overviewComputer-Assisted Risk assessment & Education: ‘CARE’ for HIV/STIs • Risk Assessment • Risk Feedback & Synthesis • Prevention Plan • Printout (option to share) Rapid HIV test log, Consent Videos Rapid HIV result follow-up

  7. Anonymous, repeatable Login

  8. Localizations

  9. Choosing a Counselor

  10. HIV Test Consent

  11. Risk Assessment

  12. Personalized Feedback

  13. Risk Synthesis

  14. Counseling & Videos

  15. Risk Reduction Plan

  16. Report with Feedback, Plan, Referrals

  17. CARE Videos Skills-building Videos(~30 minutes total) Routed based on risk, or can click on: • Abstinence • Sexual initiation (hetero & MSM) / Coming out • Sexual safety negotiation (new / existing partner, hetero & MSM) • Safer sex alternatives • Male / female condom (hetero & MSM) • Testing(hetero & MSM)

  18. What’s next? • Phase 2 = September 2003 to 2005. • Additional features: • Longitudinal follow-up & rapid HIV testing modules • Tablet PC version • Additional videos • Extensive field evaluation: • Usability testing with staff & clients in 3 US cities • Longitudinal RCT in 3 clinics in Seattle • Evaluation of rapid HIV testing CARE in Emergency Department Clinic • Dissemination plan • Planned versions: • CARE+ for persons living with HIV • CARE-Chemical Dependency for substance users

  19. Contact information Jim LarkinResources Online206.283.8300jim@ronline.com

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