Research Findings: Lauren Gooden

In the 2016 Feb 2. issue of AIDS and Behavior, SMS Assistant Professors, Lauren Gooden and Margaret Pereyra, and SMS Chair and Stephen Smith Professor, Lisa Metsch, and colleagues reported subgroup findings from a randomized controlled trial, CTN 0032: HIV Rapid Testing and Counseling in Drug Abuse Treatment Programs in the U.S. (hereafter, the ‘‘parent trial’’), conducted to assess the relative effectiveness of three HIV testing strategies on increasing receipt of HIV test results and reducing sexual risk behaviors. The parent trial was conducted among clients seeking drug or alcohol use services at 12 community-based substance use treatment programs across the U.S. representing various treatment modalities; the programs had not offered onsite HIV testing in the previous 6 months before launching the study. The trial was sponsored by the Center for Clinical Trials Network (CCTN) of the National Institute on Drug Abuse (NIDA) and the primary outcome analysis found that while there was value in implementing routine rapid HIV testing in substance use treatment centers, there was no additional benefit (e.g., decrease in sexual risk behaviors) from providing brief HIV risk-reduction counseling.

Dr. Gooden and colleagues conducted a series of post hoc, exploratory subgroup analyses to determine whether delivering brief risk-reduction counseling in conjunction with rapid testing was efficacious in reducing sexual risk behavior among any subgroups of substance users. Subgroups were defined by demographics, risk type and level, attitudes/perceptions, and behavioral history. Because the subgroup analyses focus on the efficacy of counseling, only the data from the two on-site rapid HIV testing groups (n=849) were analyzed. Participants in both groups received HIV rapid testing, completed an audio computer-assisted self-interview (ACASI) at baseline and were actively followed at 6 months post-randomization to assess sexual and injection risk behaviors. To ensure that the overall chances of a false-positive result were no more than 0.05, each test was required to meet the stricter criterion of (1 – 0.95)/K where K represents the number of independent interaction tests undertaken.  Therefore, a conservative threshold for determining statistical significance of each interaction test was (1 – 0.95)/18 = 0.0028.

Overall, results suggest that brief, client-centered HIV risk-reduction counseling may be efficacious in reducing total number of sex partners among low-risk participants (e.g., those with no baseline risky sex and those already consistently using condoms) in substance use treatment. However, because the majority of subgroups investigated did not report fewer sexual risk behaviors (acts or partners), the overall findings of this study lend support to the CDC’s 2006 recommendation to provide routine HIV testing without requiring HIV risk-reduction counseling at the time of testing. Findings should be viewed with caution given the number of post hoc subgroup analyses that were performed.

Gooden, L., Metsch, L. R., Pereyra, M. R., Malotte, C. K., Haynes, L. F., Douaihy, A., Chally, J., Mandler, R. N., & Feaster, D. J. (2016). Examining the efficacy of HIV risk-reduction counseling on the sexual risk behaviors of a national sample of drug abuse treatment clients: Analysis of subgroups. AIDS and Behavior, 20(9), 1893-1906. Read the full article here.