Brief Counseling does not Reduce STI Rates
Sexually transmitted infections (STIs) are very dangerous diseases because they can spread quickly without people knowing. One of the most deadliest STIs, HIV has no cure, which is why is it vital that people take measures to reduce their risk of STIs. In a new study, researchers examined the efficacy of using brief counseling tactics on high-risk individuals who enter clinics for HIV testing. The researchers found that brief counseling did not reduce STI rates.
For this study, researcher Lisa R. Metsch, Ph.D from Columbia Mailman School and colleagues examined the data on 5012 participants who got HIV tested at nine clinics that were affiliated with the NIDA Drug Abuse Treatment Clinical Trials Network. The clinics were from Columbia, S.C. Jacksonville, FL, Miami, FL, Los Angeles, CA, San Francisco, CA, Pittsburgh, PA, Portland, OR, Seattle, WA and Washington, DC.
Project AWARE randomly assigned the participants into two different groups between April and December of 2010. The first group conducted HIV testing while providing a brief counseling session that was designed to reduce the patient's risk of STIs. The counseling was based on an individualistic approach in which the healthcare professional would use negotiation to create a plan tailored to the patient. Since the plan was unique to the individual, researchers hoped that it would be effective in reducing one's risk of STIs. The other group received HIV testing and some information.
At the beginning of the study, the patients were assessed for multiple STIs, which included Neisseria gonorrhea, Chlamydia trachomatis, treponema pallidum (syphilis), herpes simplex virus type 2 (HSV-2) and HIV. For women, an extra test for trichomonas vaginalis was done. The researchers found that there was no difference in STI rates between the two groups after the six-month follow-up. In the group that received counseling, 250 out of 2039, which 12.3 percent, had a STI incidence. In the other group that only got information on STIs, the incidence rate was 11.1 percent, which amounted to 226 people out of 2032. The researchers found that regardless of age, race, ethnicity and sex, the STI incidence rates in both groups did not change.
"Despite the historical emphasis on risk-reduction counseling as integral to the HIV testing process, no contemporary data exist on the effectiveness of such counseling. The results of Project AWARE help fill this gap," said Dr. Metsch, who is the Stephen Smith Professor and Chair of the Department of Sociomedical Sciences at the school. "Overall, these study findings lend support for reconsidering the role of counseling as an essential adjunct to HIV testing. This inference is further buttressed by the additional costs associated with counseling at the time of testing: without evidence of effectiveness, counseling cannot be considered an efficient use of resources."
The study was published in JAMA.