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Herrmann, Evan

Psychology

2011

MA

One third of all new cases of HIV/AIDS in the U.S. are drug use related. Many cocaine users are at increased risk of HIV infection because they engage in risky injection practices and sexual behaviors. Knowledge of HIV transmission is an important determinant of HIV-related risk behavior, making development and implementation of interventions to increase my knowledge among high-risk populations such as substance abusers an important fIrst-line prevention strategy. However, only about 50% of outpatient substance abuse treatment programs provide HIV/AIDS education, likely due to the amount of time required to complete existing evidence-based interventions. This report summarizes the third phase in the systematic development of a brief educational intervention to increase HIV/AIDS knowledge among cocaine dependent outpatients at the University of Vermont. Cocaine dependent outpatients were randomly assigned to experimental (n =30)or control (n =26) conditions, and then completed two HIV/AIDS knowledge tests at study intake to assess baseline HIV/AIDS knowledge. For the present study, tests were modified from their original ''true-false'' response format to a "true-false-don't know" format in an effort to reduce guessing and provide a more accurate assessment of baseline knowledge.
Scores on both pre-tests were lower than those observed in a historical control cohort that completed tests in their original "true-false" format [75% and 72% correct vs. 85% and 84% correct respectively (p < .001)]. Participants randomized to the experimental condition then completed an educational intervention consisting of the participant meeting with a therapist to view an HIV/AIDS educational video, reviewing an HIV/AIDS education pamphlet, and reviewing their pre-tests, with emphasis placed on providing corrective feedback on items answered incorrectly or "don't know." Control participants completed a sham intervention that involved viewing a video on the psychopharmacology of cocaine and reviewing a pamphlet on the psychopharmacology ofstimulants. Participants in both conditions then completed the knowledge tests a second time. Scores on the two knowledge tests increased signifIcantly from baseline among participants who completed the educational intervention (16% and 18%, p< .001), but not among participants who completed the sham intervention (both 2% ,p > .05). Control condition participants were subsequently crossed over to receive the educational intervention, and scores increased significantly from baseline on both tests (18% and 22%,p < .001).
A subset of participants in both conditions (n=40) completed follow-up tests approximately 9 weeks after completing the educational intervention. Scores on follow-up tests remained signifIcantly higher than baseline scores (12% and 17%, p < .01). Exploratory analyses were also conducted to examine knowledge of specific risks among two subgroups at increased risk for my infection, injection users and women. Items related to the specific risk profile of each of these subgroups were identified, and knowledge scores on these items were examined at baseline and after completing the educational intervention. Results of these sub-analyses suggest injection users and women have deficits in knowledge related to their specific HIV-risk profile and that the intervention is effective at increasing HIV/AIDS knowledge in these areas. Overall, these results support this brief, inexpensive, and easily implemented intervention's efficacy for increasing HIV/AIDS knowledge among cocaine dependent outpatients.