Computer-assisted intervention for safer sex in HIV-positive men having sex with men: findings of a European randomized multi-center trial

OBJECTIVE: Men who have sex with men (MSM) are the key population most affected by HIV in Europe. We performed the first European multicenter, simple-randomized parallel-group study to test the effectiveness of a theory-guided computer-assisted intervention to improve safer sex among HIV-positive MSM.

METHODS: Between 02/2011-02/2013, 112 participants were enrolled in eight different European HIV care settings. Intervention participants received three individual counseling sessions facilitated by trained service providers using computer-assisted tools. The control-group received sexual health advice delivered as part of regular HIV care. Outcome behavior (self-reported condom use at last intercourse; combined HIV transmission risk score), its influencing factors and mediating variables were assessed at baseline, and at three and six months follow-up. Mixed effects models were used to compare primary outcomes (condom-use at last intercourse, HIV transmission risk score), and mediation analysis to explore intervention effects.

RESULTS: Condom-use at last intercourse increased more among intervention- than control participants at three months follow-up (odds ratio of 3.83; p=0.03), but not significantly at six months follow-up. Intervention participants reported a lower transmission risk at three months follow-up than controls (odds ratio compared to baseline of 11.53 and 1.28 respectively; p=0.008) but this effect became nonsignificant at six months. Intervention effects were mediated by the proximal variables self-efficacy to negotiate condom-use and condom attitudes.

CONCLUSIONS: This intervention showed short-term effectiveness. The intervention should be replicated in other settings, eventually investigating if booster-counseling sessions would yield a longer lasting effect.