Client-Centered Counseling During Routine/Opt-Out HIV-Testing in Uganda

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DESCRIPTION (provided by applicant): The applicant's long-term goal is to build a career as an independent investigator in multidisciplinary international health research focusing on HIV/AIDS research in resource-limited settings to help reduce the global HIV epidemic. In this award the candidate will build on her behavioral science background by developing knowledge and skills in public health, epidemiology, and infectious diseases with direct applications to international HIV/AIDS prevention research. The goals of this mentored award are to obtain training in these disciplines, gain expertise in methods and analysis for using biological outcomes in intervention trials, and experience conducting international HIV prevention research. The proposed research program will adapt an effective theory-based brief client-centered prevention for positives intervention designed to decrease risky sexual behavior (the OPTIONS Project), to the primary prevention setting of outpatient routine/opt-out HIV testing and counseling (RTC) in Uganda. Uganda is one of the countries most affected by the HIV epidemic and approximately 80% of those who are HIV-positive are unaware of their status. In an effort to address this situation, Uganda is expanding RTC programs. The structure and content of counseling during RTC differs dramatically from that offered during opt-in HIV-testing. Recommendations for counseling during RTC call for abandoning the client-centered counseling approach advocated in opt-in testing, in place of providing brief information and referrals for support and care services. Furthermore, unlike other HIV-counseling and testing programs, RTC places little emphasis on reducing sexual risk behavior, which is a missed opportunity for prevention. The aims of the research are: 1) conduct formative research to understand the dynamics of sexual risk behavior and elicit recommendations for adapting the intervention, 2) adapt, pilot-test, and refine the brief client-centered RTC intervention, and 3) investigate behavior change processes following RTC to identify psychosocial, social-cognitive and behavioral factors that explain short and long term sexual risk behavior change. The research will also explore the concordance between self- report and biological markers of unprotected sexual behavior and estimate the potential effect size of the brief client-centered RTC intervention on preventing new sexually transmitted infections (STIs). The proposed research will prepare the candidate to test the effects of the resultant intervention on reducing STI incidence and risky sexual behavior in a future large randomized controlled trial. This research is especially timely in Uganda and elsewhere as RTC is being scaled up. If a future trial of the proposed intervention shows it to be an effective HIV-prevention approach it is well situated to be adopted as the standard-of-care for RTC in Uganda and hopefully throughout the world as well.