P565 Personalized cognitive counseling (PCC) to reduce HIV risk following rectal gonorrhea/chlamydia diagnosis among MSM in peru

• Published in: Sexually transmitted infections Vol. 95; no. Suppl 1; p. A254
• Main Authors: Clark, Jesse, Chavez-Gomez, Susan, Castaneda-Huerta, Angelica, Passaro, Ryan, Gonzales-Saavedra, Williams, Cachay, Eduardo, Barrantes, A, Nanclares, Francisco, Dilley, James, Cabello, Robinson
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2019
• Subjects: Behavior; Chlamydia; Gonorrhea; Infections
• ISSN: 1368-4973; 1472-3263
• DOI: 10.1136/sextrans-2019-sti.639

BackgroundWe piloted a bio-behavioral intervention for MSM in Peru based on rectal gonorrhea (GC)/chlamydia (CT) screening as an integrated HIV-STI prevention strategy.MethodsBetween August-December 2018, we screened 605 MSM for rectal GC/CT using Aptima TMA and identified 101 cases among 469 HIV-uninfected men. Subjects were randomly assigned to traditional or Personalized Cognitive Counseling (PCC) at 3- and 6-Months. PCC session notes and Self-Justification Evaluation Instruments (SJEIs) were analyzed for thematic content. HIV/STI testing and behavioral risk assessments were repeated at 3- and 6-months. Statistical comparisons were conducted using Chi-square and Generalized Estimating Equations.ResultsAll participants reported reductions in condomless insertive (CIAI) and receptive anal intercourse (CRAI), with no significant differences between arms. In the Control arm, CRAI declined from a mean of 4.0 Partners (77% of recent sexual contacts) at Baseline to 1.3 (43%) at 3-Months and 0.7 (24%) at 6-Months. CRAI in the intervention arm decreased from 2.8 Partners (58% of contacts) to 1.1 (35%) to 0.8 (20%) (p≥0.05). At 3-Months, we identified 9 HIV infections and 24 new GC/CT cases across arms. At 6-Months, we diagnosed 2 HIV infections and 7 GC/CT cases (7/45; 15.6%) in the control arm (4.4%; 2/45), with 0 HIV infections (0%; 0/46) and 9 GC/CT recurrences (9/46; 19.6%) among PCC participants (p≥0.05). Thematic analysis demonstrated four common self-justifications: (1) Isolated events that don’t reflect typical behavior; (2) Informal HIV status assessments based on partner appearance or behavior; (3) Fear of ruining the moment by discussing HIV; and (4) Structural barriers to condom availability during intercourse.ConclusionOur pilot assessment supports the feasibility and acceptability of PCC for reducing HIV risk following rectal GC/CT diagnosis. Risk behavior reductions were similar between arms, though no new HIV infections were observed after PCC. Additional research is needed to apply PCC to problems of post-STI behavior change and PrEP uptake.DisclosureNo significant relationships.