Objective: We describe the effects of structural intervention to enhance the quality of HIV test counseling interaction with men who have sex with men (MSM) in San Francisco. Methods: Audio recordings of 28 rapid HIV test sessions by seven counselors were collected in two phases: before and after implementation of a waiting room intervention prior to the session. The sessions were analyzed using sequence maps to visualize and compare the sequence and distribution of four activities: counseling, information delivery, data collection, and sample collection. Results: Prior to the intervention, counselors and clients often oriented to data collection about the client's past risk as if it were a survey. In sessions recorded after the intervention, questions about past risk were dispersed throughout the session and embedded within an elaborated discussion of the client's particular life circumstances. Conclusion: Direct observation with the aid of sequence maps illuminates the ways that counselors and clients collaboratively orient to various tasks. Practice implications: We demonstrated the feasibility of a structural intervention that improved the quality of both counseling and the accuracy of client risk data without requiring additional session time or counselor training.
Bibliographical noteFunding Information:
The analysis for this paper was supported by the Center for AIDS Prevention Studies at UCSF, grant P30MH062246-06 funded by the National Institute of Mental Health (NIMH) and grant R01-HD047147-01 funded by the National Institute for Child and Human Development (NICHD). Additional staff time was provided by the San Francisco Department of Public Health. Other than financial support, the funders had no role in the study design, data collection, analysis, or writing of the paper.
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