1. Clinician Practices in Assessing Risk Behavior in US HIV Clinics Carol Dawson Rose, Grant Colfax, Lisa Metsch, David Mc Kirnan and Cari Courtenay-Quirk Study Funded by CDC PPIP PA 01190

2. Objectives n Describe HIV primary care providers’ risk assessment practices n Determine if risk assessment is more frequent among patients with higher risk practices

3. Methods n HIV-infected patients in HIV primary care clinics in Chicago, Miami, and San Francisco Bay Area enrolled into a clinic-based prevention study in 2004-2005. n Recruited in clinic waiting rooms in 2204-2005. n Participants were asked about their clinicians’ risk assessment practices. n Data were collected via audio-computer assisted survey.

4. Methods n Risk behavior defined as: In the previous 6 months, with an HIV-negative or -unknown serostatus person(s): –Had unprotected vaginal or anal intercourse –Shared injection drug-related materials (i.e. needles, cottons, cookers, water) n Clinician risk discussions defined as: –Patient report of risk discussion with clinician at most recent visit.

5. Demographic Characteristics N = 1048

6. Visits with HIV Primary Care Provider

7. Time Spent with HIV Primary Care Provider At Last Visit

8. Sex Risk Behavior with Serodiscordant Partner Patient Reported Risk Behavior n Women55 (26%) n Men, sex w/ men158 (19%) n Men, sex w/ women 38 (5%)

9. Injection Drug Use Risk n 49 (4.8%) reported injection drug use with others in the past 6 months n 18 (1.8%) shared injection drug works in the past 6 months n 15 (1.5%) shared injection drug works in the past 6 months with serodiscordant person(s)

10. What Did Patients Say Providers Discussed?

11. Are Providers Talking About Risk with Patients who Report IDU Risk?

12. Are Providers Able to Target Patients with Sexual Risk?

13. Summary n By patient report, HIV clinicians’ are talking about prevention with many of their patients less likely to discuss risk with patients who report sexual risk behavior, more likely to discuss risk with IDU. n Highlights need for clinicians to be trained on how to identify and target risk discussion with patients who are engaging in behavior that may be contributing to HIV transmission n Need for validated risk screener and risk assessment tool for HIV clinician use

14. Collaborators n University of California, San Francisco Carol Dawson Rose, RN, PhD, Principal Investigator Kelly Knight, MEd – Co-Investigator Nicholas Alvarado, MPH, Project Director Patrick Borch, BA - Field Coordinator Charles Pearson, MA – Project Coordinator n San Francisco Department of Public Health Grant Colfax, MD, Principal Investigator Sarah Wheeler, MPH, Data Manager n University of Miami Lisa Metsch, PhD, Principal Investigator n University of Chicago David Mc Kirnan, PhD, Principal Investigator n Centers for Disease Control & Prevention Dogan Eroglu, PhD - Project Officer Cari Courtenay-Quirk, PhD – Study Coordianator