Achieving sexual risk reduction among people suffering from substance use disorders (SUDs) has proven challenging but not impossible. Substance abuse treatment presents an opportunity to intervene, and there is a need for continued development of sexual risk reduction interventions that can be integrated into treatment settings. Our research group developed the Being Safe in Treatment (BEST) sexual risk assessment and feedback tool with funds from an R21 grant Computerized assistance for treatment professionals in the assessment of sexual risk (Donald Calsyn, PI; DA022940). The BEST uses the audio computer-assisted self- interviewing (ACASI) method to determine sexual risk in substance abuse treatment patients. It provides a personalized feedback report for the patient and the patient's counselor that summarizes the assessment and offers suggestions for reducing sexual risk. The primary goal of the BEST tool is to assist patients in reducing sexual risk behavior or maintaining low risk behavior. The hypothesized change mechanism is enhanced communication between counselor and patient about sexual risk. We seek funding for next steps in testing this intervention. In the R21 BEST development studies, we obtained qualitative feedback about the BEST from potential consumers (substance abuse treatment patients and their counselors) and conducted a brief pilot study on the impact of using the BEST in a methadone maintenance clinic. From these studies we received and then incorporated suggestions on ways to improve the BEST, such as reducing the time needed to take the BEST and adjusting the feedback report to better incorporate the reduced risk associated with long term monogamy. In the pilot study, receiving a BEST feedback report was associated with increased counselor knowledge about patient sexual risk behavior and an increase in patient-counselor discussions about sexual issues. However, many counselors felt unprepared to discuss sexual issues with their patients, suggesting a need for counselor training and providing the impetus for the current proposal. We propose to conduct a 2 x 2 clinical trial in which half of study counselors are randomly assigned to 1) a control condition (a 2 hour training on utilizing a BEST feedback report or 2) the same 2 hour training plus an 8 hour workshop on discussing sexual issues followed by twice monthly coaching. Patients of participating counselors will complete the BEST assessment and will be randomly assigned to receive no feedback or the BEST feedback which includes a personalized report for them and a report to their counselor. Data collection will occur for patients at baseline, 3-months, and 6-months, and for counselors at baseline, post-workshop and 3-months. The primary outcome is the number of unprotected sexual occasions in the prior 3 months and number of counseling sessions in which sexual issues were addressed. Counselor level outcomes of interest include change in counselor sexual knowledge, self-efficacy for addressing sexual matters, and skills for addressing sexual issues in counseling sessions.
Prior research has demonstrated that many individuals with substance use disorders (SUDs) are engaging in HIV risk sexual behaviors and are therefore appropriate targets for HIV prevention interventions. Substance abuse treatment provides an opportunity for sexual risk reduction; discussions about sexual risk are not occurring at an appropriate frequency in treatment settings; and clinicians can benefit from the availability of a variety of intervention tools that can be integrated into treatment programs. This project will tes the effects of counselor training and coaching, combined with a brief assessment and feedback tool, on counselor-patient communication about sex and on patient sexual risk behavior.