Background:  Integration of positive-prevention efforts into clinical care is an important step in stopping the HIV epidemic. Effective approaches have been identified in research, but results of replication in clinical practice are not well-studied. We describe a multi-site study to translate a positive prevention intervention from a clinical trial into practice.

Methods:  Options is a brief clinician-based positive-prevention intervention based on the information-motivation-behavioral skills model and proven effective in a research setting. The intervention was replicated in 15 HIV sites using training and forms adapted from the research protocol. Feasibility and fidelity were measured using standardized forms, site visits, and chart reviews to capture clinician activities and patient risk at baseline and 3 months.

Results:  Sites enrolled 1368 patients, 25% women, 59% minority, and 49% heterosexual HIV risk. At baseline, low rates of active intravenous drug users (IDU) (2%), but high rates (55%) of other mood-altering substances were seen, with a third of users reporting sex when high. Of the total, 52% reported any non-oral sex in last 3 months, with only 51% reporting always using a condom. High fidelity was seen with a median of 6 of 7 steps of the intervention completed. 90% of patients reported a risk discussion after an Options visit. The positive-prevention intervention was feasible, with high acceptance by providers and patients, and little reported disruption of clinic flow (median 5 minutes/intervention). Challenges included short visit times (<20 minutes), change in leadership, and need to adapt for patients with continued low/no risk. Majority of sites plan to incorporate Options into routine clinical practice. At 3 months, 68% of patients had fully achieved the risk-reduction goal set during an earlier visit, with an additional 12% partially achieving the goal; 85% maintained low/no risk or decreased risk. For patients with HIV^–/unknown partners, 68% maintained low risk/no risk, and 17% increased condom use, although 24% with HIV⁺ partners decreased or maintained low condom use. Patients’ report of provider knowledge of sexual activities and recreational drugs improved. There was a trend towards decrease use of non-intravenous drug use to get high.

Conclusions:  We successfully translated and replicated a clinic-based positive-prevention intervention with high feasibility, fidelity and acceptability, and high rates of achieving/maintaining low risk behavior. Effectively translating clinical research into practice is an important step to ensure that advances in prevention are replicated beyond the study setting