Risk counseling after HIV test: No effect on STIs

Risk counseling after HIV test: No effect on STIs
Risk counseling after HIV test: No effect on STIs

HealthDay News -- Brief HIV risk-reduction counseling given at the time of a rapid HIV test does not reduce the incidence of sexually transmitted infections six months later, study results indicate.

About one-in-eight patients who had a rapid HIV test combined with risk counseling developed a new STI within six months. A rate nearly identical to those who received information only about the test itself, according to Lisa R. Metsch, PhD, of Columbia University in New York City, and colleagues.

Despite similar rates of STI incidence, the per-patient cost of testing with counseling was more than double of the test alone -- $56 on average, compared with $23 for testing and information only -- they reported in Journal of the American Medical Association.

Metsch and colleagues randomly assigned 5,012 patients at U.S. sexually transmitted disease clinics to receive a rapid HIV test with brief patient-centered, HIV risk-reduction counseling, or with verbal information about HIV. Patients were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum (syphilis), herpes simplex virus 2 and HIV, whereas women were also tested for Trichomonas vaginalis.

The six-month composite incidence of sexually transmitted infections was similar in the counseling group and the information-only group (12.3% vs. 11.1%; adjusted risk ratio 1.12; 95% CI: 0.94 to 1.33), the researchers found.

"Risk-reduction counseling in conjunction with a rapid HIV test did not significantly affect sexually transmitted infection acquisition among sexually transmitted disease clinic patients, suggesting no added benefit from brief patient-centered risk-reduction counseling," the researchers wrote.

However, they continued to emphasized the importance of post-test counseling for those patients whose HIV test is positive to assist with their psychological needs and further medical care.

In an accompanying editorial, Jason Haukoos, MD, of Denver Health Medical Center and Mark Thrun, MD, of Denver Public Health, pointed out that the perception that counseling is essential for every HIV test may be hard to shake.

"In an era of shrinking resources clinicians and policymakers cannot ignore data that informs efficient clinical practice," the Haukoos and Thrun wrote. "The perception that counseling is necessary must not trump the reality that in practice, counseling is typically ineffective."

References

  1. Metsch LR et al. JAMA 2013; 310(16): 1701-1710.
  2. Haukoos JS and Thrun MW. JAMA 2013; 310(16): 1679-1680.
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