Adaptation and implementation of an evidence-based prevention counseling intervention in Texas.

HIV prevention counseling linked with testing has been shown to reduce high-risk behaviors and new sexually transmitted diseases in public clinic settings. However, few studies have been conducted evaluating the implementation of such models outside a research setting. This study sought to determine the extent to which the introduction of a standard protocol based on Project RESPECT improves the achievement of HIV prevention counseling goals of existing counseling and testing programs. Four prevention counseling programs contracting with the Texas Department of State Health Services completed a standardized 5-day training and implemented the protocols, counseling tools, and quality assurance (QA) procedures developed for the project. Introduction of the protocol was accomplished with existing program resources and significantly improved prevention counseling. Direct observation of counseling sessions demonstrated a significant improvement in attainment for eight of the nine counseling goals of initial sessions and for all counseling goals of follow-up sessions after the protocol was introduced. Client exit questionnaires reinforced this finding. Significant improvement was also found in use of counseling skills, with improvements in 6 of 10 skills observed in initial sessions and 4 of 10 skills in follow-up sessions. Challenges identified through semistructured interviews with counselors and supervisors included serving non-English-speaking and low-risk clients, mastery of the protocol, the amount of time required for QA, and implementation in settings with severe time constraints.

Prenatal HIV testing in private OB-Gyn practices in Texas.

This study evaluates the prenatal human immunodeficiency virus (HIV) testing behaviors of private obstetrics and gynecology practitioners in Texas. A statewide telephone survey of 614 providers of prenatal care determined the level of HIV testing, how testing is offered, and patient acceptance of the test. Ninety-nine percent of the practices offered HIV testing to all their pregnant patients, and 96% of the practices included HIV testing in the routine panel of tests for pregnant patients. More than 95% of the practices reported that 10% or less of the women refused the test when offered it; 73% of the practices reported no refusals. Less than half of the practices, however, discussed HIV prevention topics, and only 29% of the practices referred high-risk pregnant patients for prevention counseling. Although private practices of obstetrics and gynecology report testing almost all their prenatal patients, survey results suggest that providers could improve their prevention and patient education practices.