The Treatment Advocacy Program: A randomized controlled trial of a peer-led safer sex intervention for HIV-infected Men who have Sex with Men

Abstract

Objectives: Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a four-session, primary care-based, individual counseling intervention led by HIV-positive, MSM “peer advocates” in reducing unprotected sex with HIV-negative or unknown partners (HIV transmission risk). Methods: We randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6, and 12 months (n=251 completed all study waves). We conducted intent to treat analyses using general estimating equations to test the interaction of group (TAP versus standard care) by follow-up period. Results: At study completion, TAP participants reported greater transmission risk reduction than did those receiving standard care (X2 [2, 249]= 6.6, p=.04). Transmission risk among TAP participants decreased from 34% at baseline to about 20% at both 6- and 12-months: transmission risk ranged from 23% to 25% among comparison participants. Conclusions: TAP reduced transmission risk among HIV-positive MSM, although results were modest. Many participants and peer advocates commented favorably on the computer structure of the program. We feel that the key elements of TAP – computer-based and individually tailored session content, delivered by peers, in the primary care setting – warrant further exploration.