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Preventive care counseling practices of HIV medical care providers: Relationships between empirically-derived composite measures of performance

Osaro Mgbere, Mamta Singh, Salma Khuwaja, Raouf Arafat, Ekere James Essien, Marcia Wolverton.

Abstract
Background: Preventive care services and risk-reduction counseling are routinely offered to HIV patients
during their routine clinic visits. However, assessment of clinicians’ performance on these practices has been
difficult because of the use of many single indicators. This study attempts to evaluate the relationships between
empirically-derived composite measures of preventive care counseling practices by HIV medical care providers
(HMCP) in outpatient clinical care settings. Methods: Data used in this study were obtained from the Centers of
Disease Control and Prevention Medical Monitoring Project HMCP’ survey conducted in Houston/Harris County,
Texas between June and September of 2009. Six domain-specific composite preventive care counseling indices
developed were subjected to descriptive and correlation analyses. Results: All preventive care counseling
indices developed produced significant (P ≤ 0.05) Cronbach’s alpha coefficients that ranged from 0.64 to
0.91. The overall prevention counseling index was significantly (P < 0.001) correlated with all the domain specific
indices across patient status (r = 0.67-0.89). There were greater correlations between risk-reduction
index (RRi) and disease screening index (DSi), mental health, and substance use index (MSi) and social and
family support index in established patients (r = 0.55-0.73, P ≤ 0.01) compared to those in newly-diagnosed
patients (r = 0.44-0.56, P ≤ 0.05). Although medication and adherence index was significantly associated
with RRi (r = 0.50, P < 0.001) and DSi (r = 0.46, P < 0.001) in the sample population, these associations,
disappeared (P > 0.05) during by-group analysis based on patient status. Conclusions: Understanding the
magnitude, direction, and probability of relationships between the preventive care counseling indices may help
with providers’ self-assessment and prioritization of efforts in areas that will produce better health outcomes
and prevent transmission of HIV/sexually transmitted diseases.

Key words: HIV/AIDS, preventive counseling, HIV medical care provider, composite index, relationship.



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