Computer-Assisted Risk assessment & Education:

‘CARE’ for HIV/STI

Development teamDevelopment team:: Resources OnlineResources Online (Jim Larkin; Seattle)(Jim Larkin; Seattle)

A. Kurth, F. SpielbergA. Kurth, F. Spielberg (Univ. of Washington)(Univ. of Washington) J.D. FortenberryJ.D. Fortenberry (Indiana Univ.)(Indiana Univ.)

C.K. Malotte, S. PadillaC.K. Malotte, S. Padilla (Calif. State Long Beach)(Calif. State Long Beach)

J. St. Lawrence,J. St. Lawrence, M. McFarlane M. McFarlane (CDC)(CDC)

> 200,000 people in US, & millions globally, are unaware of their HIV+ status

Proven models of brief HIV/STI health behavior change counseling

Many sites do not have staff to deliver evidence-based HIV/STI prevention counseling

Why Provide HIV/STD Risk Assessment and Counseling?

How are we doing?

Missed OpportunityMissed Opportunity< 1/3 MDs routinely screen for STDs (St. Lawrence, et al. ‘02)

70% MDs believe counseling ineffective (Ashton et al., ‘02)

Barriers Barriers Lack of time, tools, $; pt risk assumptions, provider Lack of time, tools, $; pt risk assumptions, provider discomfort , clinician beliefs (benefits, negative pt discomfort , clinician beliefs (benefits, negative pt reactions, time constraints)? reactions, time constraints)? (Montano et al ‘02)(Montano et al ‘02)

Yet clients want to talkYet clients want to talk (Bennett et al ‘99)(Bennett et al ‘99)

Clients willing to disclose sex, drug risks when askedClients willing to disclose sex, drug risks when asked

(Gerbert et al. ‘99)(Gerbert et al. ‘99)

Health Behavior Change Model

Interactive, responsive to clientHeighten risk perceptionSupport prior behavior change attempts

Identify/develop client goalsNegotiate realistic detailed plan(Project Respect, Kamb ‘98)

What’s Needed?

Standardization of risk assessment and counseling. More disclosure with ACASI format - feasible among low

literacy populations Allows clinics to provide HIV/STD testing when providers

unavailable or makes counseling more efficient. Allows outreach organizations to provide HIV/STD testing

services when staff turn-over out-paces available counseling training.

An Interactive HIV/STD Computer Counseling Tool

CARE overviewComputer-Assisted Risk assessment & Education: ‘CARE’ for HIV/STIs

Risk Assessment

Risk Feedback & Synthesis

Prevention Plan

Printout (option to share)

VideosVideos

Rapid HIV test log, Consent

Rapid HIV result follow-up

Anonymous, repeatable Login

Localizations

Choosing a Counselor

HIV Test Consent

Risk Assessment

Personalized Feedback

Risk Synthesis

Counseling & Videos

Risk Reduction Plan

Report with Feedback, Plan, Referrals

CARE Videos

Skills-building Videos (~30 minutes total)

Routed based on risk, or can click on: Abstinence Sexual initiation (hetero & MSM) / Coming out Sexual safety negotiation (new / existing partner,

hetero & MSM)

Safer sex alternatives Male / female condom (hetero & MSM)

Testing (hetero & MSM)

What’s next?

Phase 2 = September 2003 to 2005. Additional features:

Longitudinal follow-up & rapid HIV testing modules Tablet PC version Additional videos

Extensive field evaluation: Usability testing with staff & clients in 3 US cities Longitudinal RCT in 3 clinics in Seattle Evaluation of rapid HIV testing CARE in Emergency

Department Clinic Dissemination plan

Planned versions: CARE+ for persons living with HIV CARE-Chemical Dependency for substance users

Contact information

Jim LarkinResources Online206.283.8300jim@ronline.com