Background

1. HIV Risk-Reduction: Counselor Training for a Randomized Clinical TrialLouise Haynes1, Tim Matheson2, Kathleen Brady1,Lisa Metsch3 1 Psychiatry and Behavioral Sciences, Medical University of South Carolina, 2 San Francisco Department of Public Health, 3 University of Miami CODA MCCA Wheeler CPCDS Glenwood Gibson Recovery Chesterfield Life Link Daymark LRADAC Morris Village La Frontera Background Counselor Demographics Participating Sites Fewer than one‐third of U.S drug treatment programs offer HIV testing and counseling. Concern about staff training is one reason substance abuse treatment programs have been slow to adopt HIV risk-reduction counseling and testing. In 2010, the National Institute on Drug Abuse Clinical Trials Network (CTN) completed a study designed to evaluate strategies for providing rapid HIV testing in inpatient and outpatient substance use treatment programs. This study demonstrated the value of on-site rapid HIV testing in drug treatment centers but found no additional benefit from HIV sexual risk-reduction counseling. Substance use counselors from 12 sites across the U.S. were trained to provide on‐site rapid HIV testing and a manualized HIV risk‐reduction counseling based on the RESPECT‐2 model (CDC 2010). Counselors participating in CTN study: 47% had no prior experience with HIV risk-reduction counseling 81% had no prior experience with HIV testing 14% had prior experience with HIV testing and risk reduction counseling Mean Age 39.17 (range 23-63) Mean yrs of sub abuse counseling 7.8 (range 0-20) Race/Ethnicity White 66.7% Hispanic 11.1% Black 16.7% Asian 5.6% Gender Male 25% Female 75% Education High School 2.8% Associates or Some College 11.1% Bachelors 27.8% Masters 52.8% Doctorate 5.6% Certified or licensed 44.4% Self identified in recovery 20% Methods Face to Face Counselor Training • The training team was responsible for three aspects of the intervention: counselor training, fidelity monitoring and ongoing counseling supervision. • Counselors were trained to conduct all three study arms: 1. Respect risk reduction counseling, plus offer of on-site test; 2. Information only, plus offer of on-site test; 3. Offer of referral to community testing site. • Counselor training occurred in three phases: 1) conference calls to review general HIV information, rapid HIV testing, and intervention material; 2) a face to face national meeting that included hands-on didactic and experiential practice of the intervention with immediate feedback; and 3) follow-up training to review and critique counselor recorded role-plays, with weekly calls to discuss intervention and role-plays and, if needed, individual consultation via email or telephone. • With participant consent, counseling interactions were audio-taped, and 10% were randomly reviewed by trained fidelity raters to ensure fidelity. • To strengthen counselor skills by reinforcing proper techniques and sharing constructive input, the training/ supervision team provided real time written feedback to counselors on randomly reviewed sessions. Raters assessed required activities, using a 4-point scale. • Audiotapes that averaged above 1.5 were categorized as good and those over 2.5 as excellent. • Part 1 • 1. Introductions; goals of training; review of agenda • 2. Review: role-play process; feedback guidelines; role-play evaluation forms • 3. Overview of interventions and importance of Group 3 and Group 2 interventions • 4. Model role-play and discussion – Group 3 (offer of referrals) • 5. Role-play Group 3 (offer of referrals) • 6. Debrief Group 3 role-plays in large group • 7. Model role-play and discussion – Group 2 • 8. Debrief Group 2 in large group • Part 2 • 1. Project Respect and Respect 2 counseling • 2. Model role-play and discussion: Group 1 risk assessment • 3. Role-play: Group 1 - risk assessment • 4. Debrief Group 1 - risk assessment role-plays • 5. Model role-play and discussion: Group 1 - risk reduction plan • 6. Role-play: Group 1 - risk reduction plan • 7. Debrief Group 1 • Part 3 • 1. Model role-play: HIV test results - Group 2 negative • 2. Role-play Group 2 negative result and debrief role-plays • 3. Model role-play: HIV test result – Group 1 negative • 4. Role-play Group 1 negative result and debrief role-plays • 5. Model role-play: HIV test result – Group 1 & 2 reactive • 6. Role-play Group 1 and 2 reactive result and debrief role-plays • 7. Condom demonstration • Part 4 • 1. Certification role-plays: • a. Risk assessment & risk reduction • b. Providing results Results and Conclusions • Of 198 of audiotapes reviewed for fidelity, 188 (94.9%) were rated excellent and the remaining 10 (5.1%), good. • A subset of 35 audiotapes was reviewed by multiple raters and inter-rater agreement was 97.1%. • Through a variety of training modalities substance abuse counselors, with little or no prior training or experience in HIV testing or risk-reduction counseling, were successfully trained to conduct rapid HIV testing and HIV risk-reduction counseling with substance use treatment clients. References Kamb, M. L., M. Fishbein, J. M. Douglas, Jr., F. Rhodes, J. Rogers, G. Bolan, J. Zenilman, T. Hoxworth, C. K. Malotte, M. Iatesta, C. Kent, A. Lentz, S. Graziano, R. H. Byers, and T. A. Peterman. "Efficacy of Risk-Reduction Counseling to Prevent Human Immunodeficiency Virus and Sexually Transmitted Diseases: A Randomized Controlled Trial. Project Respect Study Group." JAMA 280, no. 13 (1998): 1161-7. Metcalf, C. A., J. M. Douglas, Jr., C. K. Malotte, H. Cross, B. A. Dillon, S. M. Paul, S. M. Padilla, L. C. Brookes, C. A. Lindsey, R. H. Byers, and T. A. Peterman. "Relative Efficacy of Prevention Counseling with Rapid and Standard Hiv Testing: A Randomized, Controlled Trial (Respect-2)." Sex Transm Dis 32, no. 2 (2005): 130-8. Brown, L S. ; Kritz, St ; Goldsmith, R. J ; Bini, E J. ; Rotrosen, J ; Baker, S ; Robinson, JA. ; McAuliffe, P. Characteristics of Substance Abuse Treatment Programs Providing Services for HIV/AIDS, Hepatitis C Virus Infection, and Sexually Transmitted Infections: The National Drug Abuse Treatment Clinical Trials Network. Journal of Substance Abuse Treatment 2006;30:315-321. [doi: 1016/j.jsat.2006.02.006].