Original Study

Effectiveness of the VOICES/VOCES Sexually Transmitted Disease/Human Immunodeficiency Virus Prevention Intervention When Administered by Health Department Staff: Does It Work in the “Real World”?

Neumann, Mary Spink PhD*; O'Donnell, Lydia EdD†; Doval, Alexi San MPH†; Schillinger, Julia MD, MSc‡§; Blank, Susan MD, MPH‡§; Ortiz-Rios, Elizabeth MD, MPH; Garcia, Trinidad PhD‡; O'Donnell, Carl R. ScD, MPH†

Author Information

From the *Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †Education Development Center, Newton, MA; ‡Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; §Bureau of STD, NYC Department of Health and Mental Hygiene, New York, NY; and ¶Division of Transplantation, Healthcare Systems Bureau, Health Resources and Services Administration, Rockville, MD

The authors thank their partners in research, whose efforts made the project possible. New York City: Alana Carnegie (Public Health Educator); Franz Desire (Clinic Manager Consultant); Millicent Freeman (Director, STD Health Education Unit); Aurea Hernandez (Manager, Central Harlem STD Clinic); Ken Hutcherson (Public Health Advisor); Mark Naftel (Public Health Educator); Grace Pabaru (Public Health Educator); Steve Rubin (Deputy Director, Bureau of STD Control); Yi-Ci ‘Mary' Shao (STD Surveillance); John Thacker (Chief, STD Education Unit); Susan Wright (Director, STD Field Services). San Juan, Puerto Rico: Nilda Cruz Escribano (Assistant Health Educator); Carlos Gadea (Director of CLETS); Sandra Gavillán Sanchez (Health Educator); Arturo Geigel-Bunker (Administrator of CLETS); María I. Goyco (Health Educator); Angeles Rodriguez (Executive Director of the Central Office for STD/HIV, San Juan Department of Health); Manuel Rodriguez Bidot (STD Surveillance); Elbia Tirado. Education Development Center, Inc: Richard Duran (Field Supervisor); Athi Myint-U (Senior Research Associate).

Supported by Centers for Disease Control and Prevention, contract 200–2201–00132.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Correspondence: Mary Spink Neumann, PhD, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E37, Atlanta, GA 30333. E-mail: [email protected].

Received for publication March 23, 2010, and accepted July 1, 2010.

Sexually Transmitted Diseases 38(2):p 133-139, February 2011. | DOI: 10.1097/OLQ.0b013e3181f0c051

Background: 

Prevention providers wonder whether benefits achieved in the original, researcher-led, efficacy trials of interventions are replicated when the intervention is delivered in real-world settings by their agency's staff.

Methods: 

A replication study was conducted at 2 public sexually transmitted disease (STD) clinics (New York City and San Juan, PR). Using a controlled trial design, intervention (VOICES/VOCES) and comparison conditions (regular clinic services) were assigned in alternating 4-week blocks. Trained agency staff delivered the intervention. Effectiveness was assessed for incident STDs, redemption of coupons for condoms at neighborhood location after the visit, and improved knowledge and attitudes about STDs and condoms.

Results: 

A total of 3365 patients were recruited, completed the protocol, and followed through STD surveillance systems for an average of 17 months. Of 397 with an incident infection, 226 (13.4%) were among those enrolled during comparison blocks; 171 were among those in the intervention condition (10.2%). Controlling for site and gender, participants enrolled during intervention blocks were significantly less likely to have an incident STD reported to the surveillance system (hazard ratio, 0.78; 95% confidence interval, 0.64–0.96). Intervention block participants scored higher on scales of STD knowledge (4.89 vs. 3.87, P < 0.001) and condom knowledge, attitude, and efficacy (10.98 vs. 9.16, P < 0.001). More of those exposed to VOICES/VOCES redeemed condoms (P < 0.05). Positive effects were more consistent in New York, which may be related to fidelity of implementation.

Conclusions: 

A packaged human immunodeficiency virus prevention intervention can be delivered by agencies, with benefits similar to those achieved in the research setting.

© Copyright 2011 American Sexually Transmitted Diseases Association

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