Positive Choice | The Center for Technology and Behavioral Health

Program Overview

Positive Choice seeks to reduce substance use and risky sexual behavior using an interactive, actor-delivered, computerized counseling session.

Using the Video Doctor technology platform, Positive Choice uses motivational interviewing techniques to deliver risk-reduction messages to HIV-positive patients. Patients are first screened for risky substance use and sexual behavior. The Positive Choice program then individualizes the content of the session to match each patient’s risk profile, gender, and readiness to change. During the Positive Choice session, patients use a laptop to interact with a “Video Doctor,” who is portrayed by an actor. The Video Doctor delivers content to the patient in a non-judgmental, empathetic, and supportive manner. After the session, the patient’s primary doctor is given a summary of the patient’s risk profile, readiness to change, and suggested risk counseling statements.

Delivery:
Computer-based

Theoretical Approach(es):
Motivational Interviewing (MI)

Target Substance(s):
Illicit Drugs
Alcohol

Target Outcome(s):
Reduce drug use
Reduce risky sexual behavior

Ages:
Young Adults (18-30)
Adults (30+)

Genders:
Male
Female

Races/Ethnicities:
African American
Hispanic/Latino
Caucasian
Other

Setting:
Outpatient HIV clinics

Geographic Location:
Urban
Suburban

Country:
USA

Language:
English

Evaluations

Gilbert P, Ciccarone D, Gansky SA, Bangsberg DR, Clanon K, McPhee SJ, Calderon SH, Bogetz A, Gerbert G. PLoS One. 2008. 3(4): e1988. PMCID: PMC2292251.
Summary: A randomized controlled trial was conducted to test the efficacy of the Positive Choice program. HIV positive patients at five outpatient clinics were enrolled in the study. After completing a baseline assessment, 471 patients were eligible for study participation.ÂÂ Eligible participants had recently engaged in one or more risky behaviors. While 60% of participants had engaged in unprotected sex, 42% of the sample used illicit drugs and 39% reported risky drinking. Participants were randomly assigned to receive the Positive Choice program, or to a control group. While participants in the Positive Choice program completed a computerized session at baseline and a booster session three months later, participants in the control group received standard care. Substance use and risky sex behaviors were assessed at baseline, 3-month, and 6-month follow-ups. No decreases in risky drinking were seen in either group at 3- or 6-month assessments. Participants receiving the Positive Choice problem were less likely to use illicit drugs 3- and 6-months after baseline. Among participants using illicit drugs at baseline, 86% continued using in the control group, while only 56% continued using in the Positive Choice group. Although no decreases in rates of unprotected sex were detected at 3 months, participants assigned to Positive Choice were less likely to engage in unprotected sex at the 6-month follow-up.
Take Away: Among HIV-positive adults, the Positive Choice program is more effective than usual care in decreasing illicit drug use and unprotected sex.