The SPOT Project: Effect of Counseling Based on Motivational Interviewing Offered in Conjunction With Rapid HIV Testing on the Occurrence of Unprotected Anal Sex and Its Determinants Among Men Who Have Sex With Men (MSM) in Montreal

In Canada, the prevalence and incidence of HIV remain high among men who have sex with men (MSM). Moreover, epidemiological data show that a significant proportion of transmission can be attributed people who are unaware of their HIV status. To address these challenges, HIV testing has the potential to be a major prevention strategy. Indeed, the combination of testing and treatment (test & treat) is now seen to be one of the most promising strategies in terms of its potential contribution to the eradication of HIV.

To maximize testing among MSM, it has been recommended that services be diversified by offering HIV testing in close proximity to areas where people most at risk for HIV reside and socialize. Rapid HIV testing can also help reduce barriers in access to testing by reaching those most at risk more effectively in non-traditional venues. In addition, testing offers an excellent opportunity and psycho-affective context within which to provide individualized counseling in order to explore preventive practices and testing routines.

Since July 2009, the SPOT project has combined a number of strategies (testing services in close proximity to a residential area; free, anonymous, and rapid HIV testing; individualized preventive counseling) in an original way at an innovative community site located in the heart of Montreal's Gay Village. In the first phase of the study, standard counseling (SC) based on Quebec guidelines for rapid HIV testing was used. During the second, counseling based on a motivational interviewing approach (MIC) was developed and has been provided to participants since May 2011.

Taking advantage of the existing infrastructure, the objective of the current phase of the study is to assess the short and medium term impact of MIC and its cognitive determinants in comparison to SC. The occurrence of at-risk anal intercourse (unprotected anal sex with an HIV-positive partner or partner of unknown HIV status) will be measured at baseline and followed over six months. Four cognitive determinants of at-risk anal sex will also be measured: the importance that participants accord to taking the necessary steps to protect themselves from HIV, perceived personal efficacy in achieving this, intention to do so, and the extent to which participants have planned to do so.

To achieve this objective, a 24 months randomized trial will be implemented SPOT's community site. Participants who present for HIV testing will be randomized between the two conditions, MIC and SC, alternated at a ratio of 1/1 (experimental condition: MIC offered by a community worker; control condition: SC offered by a nurse). Outcome measures will be collected by means of questionnaires. Four measurement times are planned. A baseline questionnaire will be administered prior to pre-test counseling at the start of the initial visit. Outcome measures will be assessed at baseline (T0), and in follow-up questionnaires administered after post-test counseling at the end of the initial visit (T1), at 3 months after the initial visit (T2) and at 6 months after the initial visit (T3). Target enrolment at T0 is 900, for a final sample of 508 participants at T3, representing 254 participants per group (MIC, SC). Mechanisms will be put in place to ensure the integrity of both MIC and SC interventions as well as to retain participants and involve community members in the research process.