Peer counselling versus standard-of-care on reducing high-risk behaviours among newly diagnosed HIV-positive men who have sex with men in Beijing, China: a randomized intervention study

Yu Liu, Sten H Vermund, Yuhua Ruan, Hongjie Liu, K Rivet Amico, Jane M Simoni, Bryan E Shepherd, Yiming Shao, Han-Zhu Qian, Yu Liu, Sten H Vermund, Yuhua Ruan, Hongjie Liu, K Rivet Amico, Jane M Simoni, Bryan E Shepherd, Yiming Shao, Han-Zhu Qian

Abstract

Introduction: Reducing high-risk behaviours (i.e. multiple partnership, condomless anal/vaginal sex, alcohol use before sex, illicit drug use) after HIV diagnosis is critical for curtailing HIV transmission. We designed an intervention to explore peer- counselling in reducing high-risk behaviours among newly diagnosed HIV-positive Chinese men who have sex with men (MSM).

Methods: We randomized 367 newly diagnosed HIV-positive men to either standard-of-care (SOC; n = 183) or peer-counselling intervention (n = 184), and followed them for 12 months (visit at 0-, 3-, 6-, 9- and 12-month). SOC participants received counselling on high-risk behaviour reduction by clinic staff. Intervention participants received both SOC and peer counselling. A generalized estimating equation was used to compare pre-post diagnosis high-risk behaviour change; logistic regression was used to assess the likelihood of practicing high-risk behaviours between intervention and SOC participants. Both intent-to-treat and per-protocol (full-dosage) approaches were used for the analyses.

Results: For pre- and post-diagnosis comparisons, multiple partnership fell from 50% to 16% (p < 0.001), alcohol use before sex from 23% to 9% (p = 0.001), illicit drug use from 33% to 6% (p < 0.001), condomless anal sex from 47% to 4% (insertive from 23% to 2%; receptive from 36% to 3%; p < 0.001). In the intent-to-treat analysis accounting for repeated measures, peer counselling was more likely to reduce insertive anal sex (AOR = 0.65; 95% CI: 0.45 to 0.94), condomless anal sex (AOR = 0.27; 95% CI: 0.10 to 0.64) and illicit drug use (AOR = 0.32; 95% CI: 0.16 to 0.64). In the per-protocol analysis, peer counselling was associated with a lower likelihood of using illicit drug (OR = 0.23; 95% CI: 0.07 to 0.81) and having condomless vaginal sex with women (OR = 0.12; 95% CI: 0.07 to 0.98).

Conclusions: We observed a 14 to 43% decrease in the prevalence of selected high-risk behaviours after HIV diagnosis. Peer counselling had a greater impact in reducing condomless anal sex with men, illicit drug use and condomless vaginal sex with women over time. Future studies with exclusive peer-counselling arm are necessary to test its efficacy and effectiveness among Chinese MSM. Clinical Trial Number: NCT01904877.

Keywords: China; HIV diagnosis; high-risk behaviours; men who have sex with men; peer counselling.

© 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Figures

Figure 1
Figure 1
Screening, enrollment flow, retention and intervention dosage among study participants in the trial.
Figure 2
Figure 2
Trends of selected high‐risk behaviors across baseline (pre‐diagnosis, 0‐month) and post‐diagnosis (3‐, 6‐, 9‐ and 12‐month) visits among newly‐diagnosed HIV‐positive Chinese MSM in Beijing, China.

References

    1. Chow EP, Lau JT, Zhuang X, Zhang X, Wang Y, Zhang L. HIV prevalence trends, risky behaviours, and governmental and community responses to the epidemic among men who have sex with men in China. Biomed Res Int. 2014;2014:607261.
    1. Lu J, Xu J, Reilly KH, Li Y, Zhang CM, Jiang Y, et al. The proportion and trend of human immunodeficiency virus infections associated with men who have sex with men from Chinese voluntary blood donors: a systematic review and meta‐analysis. Transfusion. 2015;55(3):576–85.
    1. Suguimoto SP, Techasrivichien T, Musumari PM, El‐saaidi C, Lukhele BW, Ono‐Kihara M, et al. Changing patterns of HIV epidemic in 30 years in East Asia. Curr HIV/AIDS Rep. 2014;11(2):134–45.
    1. Ministry of Health of the People's Republic of China AIDS Response Progress Report. 2015.
    1. Lou J, Blevins M, Ruan Y, Vermund SH, Tang S, Webb GF, et al. Modeling the impact on HIV incidence of combination prevention strategies among men who have sex with men in Beijing, China. PLoS ONE. 2014;9(3):e90985.
    1. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test‐and‐treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.
    1. Fisher JD, Smith L. Secondary prevention of HIV infection: the current state of prevention for positives. Curr Opin HIV AIDS. 2009;4(4):279–87.
    1. Yin L, Wang N, Vermund SH, Shepherd BE, Ruan Y, Shao Y, et al. Sexual risk reduction for HIV‐infected persons: a meta‐analytic review of “positive prevention” randomized clinical trials. PLoS ONE. 2014;9(9):e107652.
    1. Gamble T, Branson B, Donnell D, Hall HI, King G, Cutler B, et al. Design of the HPTN 065 (TLC‐Plus) study: A study to evaluate the feasibility of an enhanced test, link‐to‐care, plus treat approach for HIV prevention in the United States. Clin Trials. 2017;14(4):322–32.
    1. Liu Y, Osborn CY, Qian HZ, Yin L, Xiao D, Ruan Y, et al. Barriers and facilitators of linkage to and engagement in HIV care among HIV‐positive men who have sex with men in china: a qualitative study. AIDS Patient Care STDS. 2016;30(2):70–7.
    1. Liu Y, Sun X, Qian HZ, Yin L, Yan Z, Wang L, et al. Qualitative assessment of barriers and facilitators of access to HIV testing among men who have sex with men in China. AIDS Patient Care STDS. 2015;29(9):481–9.
    1. Li H, Wei C, Tucker J, Kang D, Liao M, Holroyd E, et al. Barriers and facilitators of linkage to HIV care among HIV‐infected young Chinese men who have sex with men: a qualitative study. BMC Health Serv Res. 2017;17(1):214.
    1. Wei C, Yan H, Yang C, Raymond HF, Li J, Yang H, et al. Accessing HIV testing and treatment among men who have sex with men in China: a qualitative study. AIDS Care. 2014;26(3):372–8.
    1. Hart GJ. Peer education and community based HIV prevention for homosexual men: peer led, evidence based, or fashion driven? Sex Transm Infect. 1998;74(2):87–9.
    1. Shiner M. Defining peer education. J Adolesc. 1999;22(4):555–66.
    1. Simoni JM, Nelson KM, Franks JC, Yard SS, Lehavot K. Are peer interventions for HIV efficacious?. A systematic review AIDS Behav. 2011;15(8):1589–95.
    1. Liu Y, Li D, Vermund SH, Zhang C, Ruan Y, Yin L, et al. Associations of current marital status and living arrangements with HIV and syphilis risk: findings from a community‐based sample of men who have sex with men in China. AIDS Care. 2016;28:1–6.
    1. Ye S, Yin L, Amico R, Simoni J, Vermund S, Ruan Y, et al. Efficacy of peer‐led interventions to reduce unprotected anal intercourse among men who have sex with men: a meta‐analysis. PLoS ONE. 2014;9(3):e90788.
    1. Tao J, Qian HZ, Kipp AM, Ruan Y, Shepherd BE, Amico KR, et al. Effects of depression and anxiety on antiretroviral therapy adherence among newly diagnosed HIV‐infected Chinese MSM. AIDS. 2017;31(3):401–6.
    1. Tao J, Vermund SH, Lu H, Ruan Y, Shepherd BE, Kipp AM, et al. Impact of depression and anxiety on initiation of antiretroviral therapy among men who have sex with men with newly diagnosed HIV infections in China. AIDS Patient Care STDS. 2017;31(2):96–104.
    1. Liu Y, Qian HZ, Amico KR, Liu H, Yin L, Ruan Y, et al. Subsequent sexual risks among men who have sex with men may differ by sex of first partner and age at sexual debut: a cross‐sectional study in Beijing, China. AIDS Behav. 2017;21:2913–23.
    1. Liu Y, Ruan Y, Strauss SM, Yin L, Liu H, Amico KR, et al. Alcohol misuse, risky sexual behaviors, and HIV or syphilis infections among Chinese men who have sex with men. Drug Alcohol Depend. 2016;168:239–46.
    1. Liu Y, Li D, Vermund SH, Zhang C, Ruan Y, Yin L, et al. Associations of current marital status and living arrangements with HIV and syphilis risk: findings from a community‐based sample of men who have sex with men in China. AIDS Care. 2016;28(11):1461–6.
    1. Liu Y, Qian HZ, Ruan Y, Wu P, Osborn CY, Jia Y, et al. Frequent HIV testing: impact on HIV risk among Chinese men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(4):452–61.
    1. Liu Y, Wang J, Qian HZ, Liu H, Yin L, Lu H, et al. Seeking male sexual partners via internet and traditional venues among Chinese men who have sex with men: implications for HIV risk reduction interventions. AIDS Behav. 2016;20(10):2222–30.
    1. Suresh K. An overview of randomization techniques: an unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011;4(1):8–11.
    1. Osborn CY, Rivet Amico K, Fisher WA, Egede LE, Fisher JD. An information‐motivation‐behavioral skills analysis of diet and exercise behavior in Puerto Ricans with diabetes. J Health Psychol. 2010;15(8):1201–13.
    1. Fisher JD, Fisher WA, Amico KR, Harman JJ. An information‐motivation‐behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462–73.
    1. Amico KR, Barta W, Konkle‐Parker DJ, Fisher JD, Cornman DH, Shuper PA, et al. The information‐motivation‐behavioral skills model of ART adherence in a deep South HIV+ clinic sample. AIDS Behav. 2009;13(1):66–75.
    1. Norton WE, Amico KR, Fisher WA, Shuper PA, Ferrer RA, Cornman DH, et al. Information‐motivation‐behavioral skills barriers associated with intentional versus unintentional ARV non‐adherence behavior among HIV‐positive patients in clinical care. AIDS Care. 2010;22:1–9.
    1. Simoni JM, Amico KR, Smith L, Nelson K. Antiretroviral adherence interventions: translating research findings to the real world clinic. Curr HIV/AIDS Rep. 2010;7(1):44–51.
    1. Ma L, Ye DQ, Zhang GD, Qi HG, He YL, Hu AX, et al. Study on the quality of life and social support among people living with HIV/AIDS and their family members. Zhonghua Liu Xing Bing Xue Za Zhi. 2007;28(3):254–7.
    1. Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, et al. HIV‐related stigma: adapting a theoretical framework for use in India. Soc Sci Med. 2008;67(8):1225–35.
    1. Neilands TB, Steward WT, Choi KH. Assessment of stigma towards homosexuality in China: a study of men who have sex with men. Arch Sex Behav. 2008;37(5):838–44.
    1. Chen WT, Wantland D, Reid P, Corless IB, Eller LS, Iipinge S, et al. Engagement with health care providers affects self‐ efficacy, self‐esteem, medication adherence and quality of life in people living with HIV. J AIDS Clin Res. 2013;4(11):256.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.
    1. Brennan C, Worrall‐Davies A, McMillan D, Gilbody S, House A. The hospital anxiety and depression scale: a diagnostic meta‐analysis of case‐finding ability. J Psychosom Res. 2010;69(4):371–8.
    1. Zhang H, Teng T, Lu H, Zhao Y, Liu H, Yin L, et al. Poppers use and risky sexual behaviors among men who have sex with men in Beijing, China. Drug Alcohol Depend. 2016;160:42–8.
    1. Liu Y, Ruan Y, Vermund SH, Osborn CY, Wu P, Jia Y, et al. Predictors of antiretroviral therapy initiation: a cross‐sectional study among Chinese HIV‐infected men who have sex with men. BMC Infect Dis. 2015;15:570.
    1. Zhang C, Liu Y, Sun X, Wang J, Lu HY, He X, et al. Substance use and HIV‐risk behaviors among HIV‐positive men who have sex with men in China: repeated measures in a cohort study design. AIDS Care. 2017;29(5):644–53.
    1. Harrell Frank E.. Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis. New York: Springer; 2015.
    1. Heijman T, Geskus RB, Davidovich U, Coutinho RA, Prins M, Stolte IG. Less decrease in risk behaviour from pre‐HIV to post‐HIV seroconversion among MSM in the combination antiretroviral therapy era compared with the pre‐combination antiretroviral therapy era. Aids. 2012;26(4):489–95.
    1. Khanna AS, Goodreau SM, Gorbach PM, Daar E, Little SJ. Modeling the impact of post‐diagnosis behavior change on HIV prevalence in Southern California men who have sex with men (MSM). AIDS Behav. 2014;18(8):1523–31.
    1. Gorbach PM, Javanbakht M, Bolan RK. Behavior change following HIV diagnosis: findings from a Cohort of Los Angeles MSM. AIDS Care. 2017;30:1–5.
    1. Firn S, Norman IJ. Psychological and emotional impact of an HIV diagnosis. Nurs Times. 1995;91(8):37–9.
    1. Hughes JP, Haley DF, Frew PM, Golin CE, Adimora AA, Kuo I, et al. Regression to the mean and changes in risk behavior following study enrollment in a cohort of U.S. women at risk for HIV. Ann Epidemiol. 2015;25(6):439–44.
    1. Zhu JL, Zhang HB, Wu ZY, Zheng YJ, Xu J, Wang J, et al. HIV risk behavior based on intervention among men who have sex with men peer groups in Anhui province. Zhonghua Yu Fang Yi Xue Za Zhi. 2008;42(12):895–900.
    1. Zhang HB, Zhu JL, Wu ZY, Pang L, Zhang LL, Li T, et al. Intervention trial on HIV/AIDS among men who have sex with men based on venues and peer network. Zhonghua Yu Fang Yi Xue Za Zhi. 2009;43(11):970–6.
    1. McKirnan DJ, Tolou‐Shams M, Courtenay‐Quirk C. The treatment advocacy program: a randomized controlled trial of a peer‐led safer sex intervention for HIV‐infected men who have sex with men. J Consult Clin Psychol. 2010;78(6):952–63.
    1. Kelly JA, St Lawrence JS, Diaz YE, Stevenson LY, Hauth AC, Brasfield TL, et al. HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis. Am J Public Health. 1991;81(2):168–71.
    1. Collins CB Jr, Hearn KD, Whittier DN, Freeman A, Stallworth JD, Phields M. Implementing packaged HIV‐prevention interventions for HIV‐positive individuals: considerations for clinic‐based and community‐based interventions. Public Health Rep. 2010;125(Suppl 1):55–63.
    1. Cohen MS, Gay CL. Treatment to prevent transmission of HIV‐1. Clin Infect Dis. 2010;50(Suppl 3):S85–95.
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV‐1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner