Multicentre RCT and economic evaluation of a psychological intervention together with a leaflet to reduce risk behaviour amongst men who have sex with men (MSM) prescribed post-exposure prophylaxis for HIV following sexual exposure (PEPSE): A protocol

Background: Post-exposure prophylaxis (PEP) following sexual exposure to HIV has been recommended as a method of preventing HIV infection in the UK. Men who have sex with men (MSM) are the group most affected by HIV in the UK and their sexual risk taking behaviour is reported to be increasing. One-to-one behavioural interventions, such as motivational interviewing (MI) have been recommended to reduce HIV in high risk groups. The Information, Motivation and Behavioral skills (IMB) model has been shown to provide a good basis for understanding and predicting HIV-relevant health behaviour and health behaviour change, however the IMB has yet to be applied to PEP after risky sexual exposure. The primary aim of this trial is to examine the impact of MI augmented with information provision and behavioural skills building (informed by the IMB Model), over and above usual care, on risky sexual behaviour in MSM prescribed PEP after potential sexual exposure. A secondary aim of this research is to examine the impact of the intervention on adherence to PEP. This study will also provide estimates of the cost-effectiveness of the intervention. Methods: A manualised parallel group randomised controlled trial with economic evaluation will be conducted. The primary outcome is the proportion of risky sexual practices. Secondary outcomes include: i) Levels of adherence to PEP treatment; ii) Number of subsequent courses of PEP; iii) Levels of motivation to avoid risky sexual behaviours; iv) Levels of HIV risk-reduction information/knowledge; v) Levels of risk reduction behavioural skills; vi) Diagnosis of anal gonorrhoea, Chlamydia and/or HIV. 250 participants will be asked to self-complete a questionnaire at four time points during the study (at 0,3,6,12 months). The intervention will consist of a two-session, fixed duration, telephone administered augmented MI intervention based on the IMB model. A newly developed treatment manual will guide the selection of persuasive communication strategies as appropriate for each participant and will be based on underlying change mechanisms specified by the IMB theoretical framework. Information provision and skills building will also be included in the intervention package through the use of information leaflets and tailored action plans. Fidelity of intervention delivery will be assessed. Discussion: The results from this NIHR funded study will identify whether it is appropriate and cost-effective to intervene using one-to-one telephone calls with MSM seeking PEP. If the intervention is effective, further work will be needed on training staff to deliver the intervention competently

Successful weight management and health behaviour change using a health trainer model

Aim: NHS Great Yarmouth and Waveney is an area of high deprivation and it is estimated that 49% of the adult population are overweight or obese. The health trainer model, which involves recruiting trainers from local communities, offers an innovative way of supporting individuals in managing their weight through one-to-one support. The aim of the current study was to evaluate the effectiveness of a health trainer-led intervention in terms of weight loss and behaviour change. Methods: Data were collected from all participants who visited a health trainer for the purpose of weight loss between February 2008 and March 2011. All participants were seen on a oneto- one basis, with the setting and length of the intervention varying according to individual requirements (median 21 weeks, IQR 12.4-29.6). Weight change was the primary outcome measure; secondary outcomes were blood pressure, fruit and vegetable intake and physical activity levels, measured using established health trainer data recording systems. Data on secondary outcomes were not available for all participants due to lack of compliance. Results: Using intention-to-treat analysis, average weight change was -2.5 kg (95% CI - 2.7 - -2.1, n = 541, p <.001) and weight gain was prevented in 90% of participants (n = 487). The number of participants classified as hypertensive reduced from 60% (n = 66) to 41% (n = 45) over the period of the intervention. In terms of behaviour change, fruit and vegetable intake increased significantly by 2.4 portions per day (95% CI 2.1-2.7, n = 248, p <.001) with 46% (n = 115) of participants increasing their intake to five portions per day. 68% of participants for whom data were available (n = 227) reported an increase in moderate physical activity, with time increasing by 59.3 minutes per week (95% CI 46.3-72.4, p <.001). Conclusions: The health trainer service in Great Yarmouth and Waveney may be effective in helping participants to manage their weight and change their health-related behaviour. Although the degree of weight loss reported was moderate given the high levels of deprivation and the health needs of the local population, these were promising findings. To improve the current evidence base for the effectiveness of health trainer-led interventions, studies need to see if these findings are replicable in other population groups and in other settings