Kamb M L, Fishbein M, Douglas J M, Rhodes F, Rogers J, Bolan G, Zenilman J, Hoxworth T, Malotte C K, Iatesta M, Kent C, Lentz A, Graziano S, Byers R H, Peterman T A
Division of HIV/AIDS Prevention, National Center for HIV, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA. 1998 Oct 7;280(13):1161-7. doi: 10.1001/jama.280.13.1161.
CONTEXT: The efficacy of counseling to prevent infection with the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) has not been definitively shown. OBJECTIVE: To compare the effects of 2 interactive HIV/STD counseling interventions with didactic prevention messages typical of current practice. DESIGN: Multicenter randomized controlled trial (Project RESPECT), with participants assigned to 1 of 3 individual face-to-face interventions. SETTING: Five public STD clinics (Baltimore, Md; Denver, Colo; Long Beach, Calif; Newark, NJ; and San Francisco, Calif) between July 1993 and September 1996. PARTICIPANTS: A total of 5758 heterosexual, HIV-negative patients aged 14 years or older who came for STD examinations. INTERVENTIONS: Arm 1 received enhanced counseling, 4 interactive theory-based sessions. Arm 2 received brief counseling, 2 interactive risk-reduction sessions. Arms 3 and 4 each received 2 brief didactic messages typical of current care. Arms 1, 2, and 3 were actively followed up after enrollment with questionnaires at 3, 6, 9, and 12 months and STD tests at 6 and 12 months. An intent-to-treat analysis was used to compare interventions. MAIN OUTCOME MEASURES: Self-reported condom use and new diagnoses of STDs (gonorrhea, chlamydia, syphilis, HIV) defined by laboratory tests. RESULTS: At the 3- and 6-month follow-up visits, self-reported 100% condom use was higher (P<.05) in both the enhanced counseling and brief counseling arms compared with participants in the didactic messages arm. Through the 6-month interval, 30% fewer participants had new STDs in both the enhanced counseling (7.2%; P= .002) and brief counseling (7.3%; P= .005) arms compared with those in the didactic messages arm (10.4%). Through the 12-month study, 20% fewer participants in each counseling intervention had new STDs compared with those in the didactic messages arm (P = .008). Consistently at each of the 5 study sites, STD incidence was lower in the counseling intervention arms than in the didactic messages intervention arm. Reduction of STD was similar for men and women and greater for adolescents and persons with an STD diagnosed at enrollment. CONCLUSIONS: Short counseling interventions using personalized risk reduction plans can increase condom use and prevent new STDs. Effective counseling can be conducted even in busy public clinics.
背景：咨询服务在预防人类免疫缺陷病毒（HIV）感染及其他性传播疾病（STD）方面的效果尚未得到明确证实。 目的：比较两种交互式HIV/STD咨询干预措施与当前常规说教式预防信息的效果。 设计：多中心随机对照试验（RESPECT项目），参与者被分配到三种个体面对面干预措施中的一种。 地点：1993年7月至1996年9月期间的五家公共性病诊所（马里兰州巴尔的摩市；科罗拉多州丹佛市；加利福尼亚州长滩市；新泽西州纽瓦克市；加利福尼亚州旧金山市）。 参与者：总共5758名年龄在14岁及以上前来进行性病检查的异性恋、HIV阴性患者。 干预措施：第一组接受强化咨询，共4次基于理论的交互式课程。第二组接受简短咨询，共2次降低风险的交互式课程。第三组和第四组分别接受当前护理中常见的2次简短说教式信息。第一组、第二组和第三组在入组后分别在3、6、9和12个月进行问卷调查，并在6和12个月进行性病检测，积极随访。采用意向性分析来比较干预措施。 主要观察指标：自我报告的避孕套使用情况以及通过实验室检测确定的新诊断性病（淋病、衣原体感染、梅毒、HIV）。 结果：在3个月和6个月的随访中，强化咨询组和简短咨询组自我报告的100%避孕套使用率均高于说教式信息组（P<0.05）。在6个月期间，强化咨询组（7.2%；P=0.002）和简短咨询组（7.3%；P=0.005）中新发性病患者比说教式信息组（10.4%）少30%。在为期12个月的研究中，与说教式信息组相比，每种咨询干预措施中的新发STD患者少20%（P=0.008）。在5个研究地点中的每一个，咨询干预组的性病发病率始终低于说教式信息干预组。性病减少情况在男性和女性中相似，在青少年和入组时被诊断患有性病的人群中更为明显。 结论：使用个性化降低风险计划的简短咨询干预可以增加避孕套使用并预防新发性病。即使在繁忙的公共诊所也可以进行有效的咨询。
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