Schwarcz Sandra K, Chen Yea-Hung, Murphy Jessie L, Paul Jay P, Skinta Matthew D, Scheer Susan, Vittinghoff Eric, Dilley James W
School of Medicine, University of California, San Francisco, CA, USA.
AIDS Care. 2013;25(1):1-10. doi: 10.1080/09540121.2012.674095. Epub 2012 May 9.
The increased life expectancy and well-being of HIV-infected persons presents the need for effective prevention methods in this population. Personalized cognitive counseling (PCC) has been shown to reduce unprotected anal intercourse (UAI) with a partner of unknown or different serostatus among HIV-uninfected men who have sex with men (MSM). We adapted PCC for use among HIV-infected MSM and tested its efficacy against standard risk-reduction counseling in a randomized clinical trial in San Francisco. Between November 2006 and April 2010, a total of 374 HIV-infected MSM who reported UAI with two or more men of negative or unknown HIV serostatus in the previous 6 months were randomized to two sessions of PCC or standard counseling 6 months apart. The primary outcome was the number of episodes of UAI with a non-primary male partner of different or unknown serostatus in the past 90 days, measured at baseline, 6, and 12 months. Surveys assessed participant satisfaction with the counseling. The mean number of episodes of UAI at baseline did not differ between PCC and control groups (2.97 and 3.14, respectively; p=0.82). The mean number of UAI episodes declined in both groups at 6 months, declined further in the PCC group at 12 months, while increasing to baseline levels among controls; these differences were not statistically significant. Episode mean ratios were 0.76 (95% confidence interval [CI] 0.25-2.19, p=0.71) at 6 months and 0.48 (95% CI 0.12-1.84, p=0.34) at 12 months. Participants in both groups reported a high degree of satisfaction with the counseling. The findings from this randomized trial do not support the efficacy of a two-session PCC intervention at reducing UAI among HIV-infected MSM and indicate the continued need to identify and implement effective prevention methods in this population.
艾滋病毒感染者预期寿命的延长和生活质量的提高，凸显了在这一人群中采取有效预防措施的必要性。个性化认知咨询（PCC）已被证明可以减少未感染艾滋病毒的男男性行为者（MSM）与血清学状态未知或不同的伴侣之间的无保护肛交（UAI）。我们对PCC进行了调整，使其适用于感染艾滋病毒的男男性行为者，并在旧金山的一项随机临床试验中测试了其相对于标准风险降低咨询的效果。在2006年11月至2010年4月期间，共有374名感染艾滋病毒的男男性行为者被随机分为两组，这374人在过去6个月内报告与两名或更多艾滋病毒血清学状态为阴性或未知的男性发生过无保护肛交，他们被随机分配接受两次间隔6个月的PCC或标准咨询。主要结局是在过去90天内与血清学状态不同或未知的非主要男性伴侣发生无保护肛交的次数，分别在基线、6个月和12个月时进行测量。调查评估了参与者对咨询的满意度。PCC组和对照组在基线时无保护肛交的平均次数没有差异（分别为2.97次和3.14次；p=0.82）。两组在6个月时无保护肛交的平均次数均有所下降，PCC组在12个月时进一步下降，而对照组则回升至基线水平；这些差异无统计学意义。6个月时发作平均比率为0.76（95%置信区间[CI]0.25 - 2.19，p=0.71），12个月时为0.48（95%CI 0.12 - 1.84，p=0.34）。两组参与者对咨询的满意度都很高。这项随机试验的结果不支持为期两次的PCC干预在减少感染艾滋病毒的男男性行为者无保护肛交方面的有效性，并表明仍需继续在这一人群中确定和实施有效的预防方法。
