Evaluation of a real-time virtual intervention to empower persons living with HIV to use therapy self-management: study protocol for an online randomized controlled trial

Trials

Ghayas Fadel³  Cécile Tremblay⁶  Joanne Otis¹  Pilar Ramirez-Garcìa⁴  Geneviève Rouleau⁷  Yann-Gaël Guéhéneuc²  Gaston Godin⁵  José Côté⁴ 

[1] Canada Research Chair in Health Education, Université du Québec à Montréal, Quebec, Canada;Canada Research Chair on Software Patterns and Patterns of Software, École Polytechnique Montreal, Quebec, Canada;Quebec Coalition Of Community-Based HIV/AIDS Organizations (COCQ-SIDA), Montreal, Quebec, Canada;Université de Montréal, Quebec, Canada;Canada Research Chair on Behaviour and Health, Université Laval, Quebec, Canada;Research Centre of the Centre Hospitalier de l’Université de Montréal, Quebec, Canada;Research Chair in Innovative Nursing Practices, Research Centre of the Centre Hospitalier de l’Université de Montréal, Quebec, Canada

关键词: Anti-retroviral therapy;    Adherence;    Self-management program;    People living with HIV;    Web-based study;    Randomized controlled trial;   

Others  :  1095284
DOI  :  10.1186/1745-6215-13-187

 received in 2012-02-14, accepted in 2012-09-21,  发布年份 2012

【 摘 要 】

Background

Living with HIV makes considerable demands on a person in terms of self-management, especially as regards adherence to treatment and coping with adverse side-effects. The online HIV Treatment, Virtual Nursing Assistance and Education (Virus de I’immunodéficience Humaine–Traitement Assistance Virtuelle Infirmière et Enseignement; VIH-TAVIE™) intervention was developed to provide persons living with HIV (PLHIV) with personalized follow-up and real-time support in managing their medication intake on a daily basis. An online randomized controlled trial (RCT) will be conducted to evaluate the efficacy of this intervention primarily in optimizing adherence to combination anti-retroviral therapy (ART) among PLHIV.

Methods/design

A convenience sample of 232 PLHIV will be split evenly and randomly between an experimental group that will use the web application, and a control group that will be handed a list of websites of interest. Participants must be aged 18 years or older, have been on ART for at least 6 months, and have internet access. The intervention is composed of four interactive computer sessions of 20 to 30 minutes hosted by a virtual nurse who engages the PLHIV in a skills-learning process aimed at improving self-management of medication intake. Adherence constitutes the principal outcome, and is defined as the intake of at least 95% of the prescribed tablets. The following intermediary measures will be assessed: self-efficacy and attitude towards antiretroviral medication, symptom-related discomfort, and emotional support. There will be three measurement times: baseline (T0), after 3 months (T3) and 6 months (T6) of baseline measurement. The principal analyses will focus on comparing the two groups in terms of treatment adherence at the end of follow-up at T6. An intention-to-treat (ITT) analysis will be carried out to evaluate the true value of the intervention in a real context.

Discussion

Carrying out this online RCT poses various challenges in terms of recruitment, ethics, and data collection, including participant follow-up over an extended period. Collaboration between researchers from clinical disciplines (nursing, medicine), and experts in behavioral sciences information technology and media will be crucial to the development of innovative solutions to supplying and delivering health services.

Trial registration

CE 11.184 / NCT 01510340

【 授权许可】

   
2012 Côté et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B: Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. AIDS 2004, 18:1429-1433.
• [2]Hogg RS, Yip B, Kully C, Craib KJ, O'Shaughnessy MV, Schechter MT, Montaner JSG: Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. Can Med Assoc J 1999, 160:659-665.
• [3]Genberg B, Wilson I, Bangsberg D, Arnsten J, Goggin K, Remien R, Simoni J, Gross R, Reynolds N, Rosen M, et al.: Patterns of antiretroviral therapy adherence and impact on HIV RNA among patients in North America. AIDS 2012, 26:1415-1423.
• [4]Parienti J-J, Das-Douglas M, Massari V, Guzman D, Deeks SG, Verdon R, Bangsberg DR: Not All Missed Doses Are the Same: Sustained NNRTI Treatment Interruptions Predict HIV Rebound at Low-to-Moderate Adherence Levels. PLoS One 2008, 3:e2783.
• [5]Bangsberg DR: Less than 95% Adherence to Nonnucleoside Reverse-Transcriptase Inhibitor Therapy Can Lead to Viral Suppression. Clin Infect Dis 2006, 43:939-941.
• [6]Martin CP, Fain MJ, Klotz SA: The older HIV-positive adult: A critical review of the medical literature. Am J Med 2008, 121:1032-1037.
• [7]Gardner EM, Burman WJ, Steiner JF, Anderson PL, Bangsberg DR: Antiretroviral medication adherence and the development of class-specific antiretroviral resistance. AIDS 2009, 23:1035-1046.
• [8]Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. http://aidsinfo.nih.gov/guidelines webcite
• [9]De Bruin M, Hospers HJ, Van den Borne HW, Kok G, Prins JM: Theory -and evidence-based intervention to improve adherence to antiretroviral therapy among HIV-infected patients in The Netherlands: a pilot study. AIDS Patient Care STDS 2005, 19:384-393.
• [10]Dilorio C, Resnicow K, McDonnell M, Soet J, McCarthy F, Yeager K: Using a motivational interviewing to promote adherence to antiretroviral medications: a pilot study. J Assoc Nurses AIDS Care 2003, 14:52-62.
• [11]Kalichman SC, Cherry J, Cain D: Nurse-delivered antiretroviral treatment adherence intervention for people with low literacy skills and living with HIV/AIDS. J Assoc Nurses AIDS Care 2005, 16:3-15.
• [12]Shegog R, Markham CM, Leonard AD, Bui TC, Paul ME: “+CLICK”: pilot of a web-based training program to enhance ART adherence among HIV-positive youth. AIDS Care 2011, 24:310-318.
• [13]Chiou PY, Kuo BI, Lee MB, Chen YM, Chuang P, Lin PC: A program of symptom management for improving quality of life and drug adherence. J Adv Nurs 2006, 55:169-179.
• [14]Goujard C, Bernard N, Sohier N, Peyramond D, Lançon F, Chwalow J, Benoit A, Delfraissy J-F: Impact of a patient education program on adherence to HIV medication: a randomized clinical trial. J Acquir Immune Defic Syndr 2003, 34:191-194.
• [15]Holzemer WL, Bakken S, Portillo CJ, Grimes R, Welch J, Wantland D, Mullan JT: Testing a nurse-tailored HIV medication adherence intervention. Nurs Res 2006, 55:189-197.
• [16]Javanbakht M, Prosser P, Grimes T, Weinstein M, Farthing C: Efficacy of an individualized support program with contingent reinforcement among nonadherent HIV-positive patients. J Int Assoc Physicians AIDS Care 2006, 5:143-150.
• [17]Koenig LJ, Pals SL, Bush T, Stratford D, Ellerbrock TV, Palmore MP: Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy. Health Psychol 2008, 27:159-169.
• [18]Pradier C, Bentz L, Spire B, Tourette-Turgis C, Morin M, Souville M, Rebillon M, Fuzibet J, Pesce A, Dellamonica P, Moatti J: Efficacy on an educational and counseling intervention on adherence to highly active antiretroviral therapy: french prospective controlled study. HIV Clin Trials 2003, 4:121-131.
• [19]Weber R, Christen L, Christen S, Tschopp S, Hansjoerg Z, Schnedier C, Schmitt J, Opravil M, Günthard HF, Ledergerber B: Effect of individual cognitive behaviour intervention on adherence to antiretroviral therapy: prospective randomized trial. Antivir Ther 2004, 9:85-95.
• [20]Williams BA, Fennie PK, Bova AC, Burgess DJ, Danvers AK, Dieckhaus DK: Home visits to improve adherence to highly active antiretroviral therapy: a randomized controlled trial. J Acquir Immune Defic Syndr 2006, 42:314-321.
• [21]Chung MH, Richardson BA, Tapia K, Benki-Nugent S, Kiarie JN, Simoni JM, Overbaugh J, Attwa M, John-Stewart GC: A Randomized Controlled Trial Comparing the Effects of Counseling and Alarm Device on HAART Adherence and Virologic Outcomes. PLoS Med 2011, 8:e1000422.
• [22]da Costa TM, Barbosa BJP, e Costa DAG, Sigulem D, de Fátima MH, Filho AC, Pisa IT: Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inf 2012, 81:257-269.
• [23]Rueda S, Park-Wyllie LY, Bayoumi AM, Tynan AM, Antoniou TA, Rourke SB, Glazier RH: Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database Syst Rev 2006, 3:CD001442.
• [24]Haynes RB, Ackloo E, McDonald HP, Yao X: Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008, 2:CD000011.
• [25]Kripalani S, Yao X, Haynes RB: Interventions to enhance medication adherence in chronic medical conditions: a Systematic review. Arch Intern Med 2007, 167:540-549.
• [26]Bärnighausen T, Chaiyachati K, Chimbindi N, Peoples A, Haberer J, Newell M-L: Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. Lancet Infect Dis 2011, 11:942-951.
• [27]Horvath T, Azman H, Kennedy G, Rutherford G: Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev 2012, 3:CD009756.
• [28]Dorr D, Bonner LM, Cohen AN, Shoai RS, Perrin R, Chaney E, Young AS: Informatics systems to promote improved care for chronic illness: a literature review. J Am Med Inform Assoc 2007, 14:156-163.
• [29]Lewis D: Computers in patient education. Comput Inform Nurs 2003, 21:88-96.
• [30]Nguyen HQ, Carrieri-Kohlman V, Rankin SH, Slaughter R, Stulbarg MS: Internet-based patient education and support interventions: a review of evaluation studies and directions for future research. Comput Biol Med 2004, 34:95-112.
• [31]Young AS, Chaney E, Shoai R, Bonner L, Cohen AN, Doebbeling B, Dorr D, Goldstein MK, Kerr E, Nichol P, Perrin R: Information technology to support improved care for chronic illness. J Gen Intern Med 2007, 22:425-430.
• [32]Bental DS, Cawsey A, Jones R: Patient information systems that tailor to the individual. Patient Educ Couns 1999, 36:171-180.
• [33]Lewis D: Computer-based approaches to patient education. J Am Med Inform Assoc 1999, 6:272-282.
• [34]Revere D, Dunbar PJ: Review of computer-generated outpatient health behavior interventions. J Am Med Inform Assoc 2001, 8:62-79.
• [35]Kreuter MW, Bull FC, Clark EM, Oswald DL: Understanding how people process health information: a comparaison of tailored and untailored weight loss materials. Health Psychol 1999, 18:1-8.
• [36]Kreuter MW, Farrell D, Olevitch L, Brennan L: Tailored Health Messages: Customizing Communication with Computer Technology. Mahwah, NJ: Lawrence Erlbaum; 1999.
• [37]Kreuter MW, Skinner CS: Tailoring, what's in a name? Health Educ Res 2000, 15:1-4.
• [38]Dijkstra A: Working mechanisms of computer-tailored health education: evidence from smoking cessation. Health Educ Res 2005, 20:527-539.
• [39]Dijkstra A, De Vries H: The development of computer-generated tailored interventions. Patient Educ Couns 1999, 36:193-203.
• [40]De Vries H, Brug J: Computed-tailored interventions motivating people to adopt health promoting behaviours: Introduction to a new approach. Patient Educ Couns 1999, 36:99-105.
• [41]Lancaster T, Stead LF: Self-help interventions for smoking cessation. Cochrane Database Syst Rev 2003.
• [42]Velicer WF, Prochaska JO: An expert system intervention for smoking cessation. Patient Educ Couns 1999, 36:119-129.
• [43]Walters ST, Wright JA, Shegog R: A review of computer and Internet-based interventions for smoking behavior. Addict Behav 2006, 31:264-277.
• [44]Strecher VJ: Computer-tailored smoking cessation materials: a review and discussion. Patient Educ Couns 1999, 36:107-117.
• [45]Strecher VJ, Wang C, Derry H, Wildenhaus K, Johnson C: Tailored intervention for multiple risk behaviors. Health Educ Res 2002, 17:619-26.
• [46]Brug J, Campbell M, van Assema P: The application and impact of computer-generated personalized nutrition education: a review of the literature. Patient Educ Couns 1999, 36:145-156.
• [47]De Bourdeaudhuij I, Stevens V, Vandelanotte C, Brug J: Evaluation of an interactive computer-tailored nutrition intervention in a real-life setting. Ann Behav Med 2007, 33:39-48.
• [48]Baker AH, Wardle J: Increasing fruits and vegetable intake among adults attending colorectal cancer screening. Cancer Epidemiol Biomark Prev 2002, 11:203-206.
• [49]Pérez-Rodrigo C, Wind M, Hildonen C, Bjelland M, Aranceta J, Klepp KI, Brug J: The pro-children intervention: applying the intervention mapping protocol to develop a school-based fruit and vegetable promotion programme. Ann Nutr Metab 2005, 49:267-277.
• [50]Jerant A, Kravitz RL, Rooney M, Amerson S, Kreuter M, Franks P: Effects of a tailored interactive multimedia computer program on determinants of colorectal cancer screening: a randomized controlled pilot study in physician offices. Patient Educ Couns 2007, 66:67-74.
• [51]Nooijer J, Lechner L, Candel M, de Vries H: A randomized controlled study of short-term and long-term effects of tailored information versus general information on intention and behavior related to early detection of cancer. Cancer Epidemiol Biomark Prev 2002, 11:1489-1491.
• [52]Gilbert P, Ciccarone D, Gansky SA, Bangsberg DR, Clanon K, McPhee SJ, Calderon SH, Bogetz A, Gerbert B: Interactive "video doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings. PLoS One 2008, 3:e1988.
• [53]Kiene SM, Barta WD: A brief individualized computer-delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior. J Adolesc Health 2006, 39:404-410.
• [54]Lau JTF, Lau M, Cheung A, Tsui HY: A randomized controlled study to evaluate the efficacy of an internet-based intervention in reducing HIV risk behaviors among men who have sex with men in Hong Kong. AIDS Care 2008, 20:1-9.
• [55]Marsch LA, Bickel WK: Efficacy of computer-based HIV/AIDS education for injection drug users. Am J Health Behav 2004, 28:316-326.
• [56]Gagnon H, Godin G, Alary M, Bruneau J, Otis J: A randomized trial to evaluate the efficacy of a computer-tailored intervention to promote safer injection practices among drug users. AIDS Behav 2010, 14:538-548.
• [57]Lustria MLA, Cortese J, Noar SM, Gulueckauf RL: Computer-tailored health interventions delivered over the web: Review and analysis of key components. Patient Educ Couns 2009, 74:156-173.
• [58]Murray E, Burns ME, See Thai S, Lai R, Nazareth I: Interactive health communication applications for people with chronic disease (review). Cochrane Database Syst Rev 2009, 1:CD000389.
• [59]Joseph CLM, Peterson E, Havstad S, Johnson CC, Hoerauf S, Stringer S, Gibson-Scipio W, Ownby DR, Elston-Lafata J, Pallonen U, Strecher V: A web-based, tailored asthma management program for urban African-American high school students. Am J Respir Crit Care Med 2007, 175:888-895.
• [60]Hee-Sung K: Impact of web-based nurse's education on glycosylated hemoglobin in type 2 diabetic patients. J Clin Nurs 2007, 16:1361-1366.
• [61]Kim CJ, Kang DH: Utility of a web-based intervention for individuals with type 2 diabetes: the impact on physical activity levels and glycemic control. Comput Inform Nurs 2006, 24:337-345.
• [62]Wangberg SC: An internet-based diabetes self-care intervention tailored to self-efficacy. Health Educ Res 2008, 23:170-179.
• [63]Beranova E, Sykes C: A systematic review of computer-based softwares for educating patients with coronary heart disease. Patient Educ Couns 2007, 66:21-28.
• [64]Evangelista LS, Stromberg A, Westlake C, Ter-Galstanyan A, Anderson N, Dracup K: Developing a web-based education and counseling program for heart failure patients. Prog Cardiovasc Nurs 2006, 21:196-201.
• [65]Strömberg A, Dahlström U, Fridlund B: Computer-based education for patients with chronic heart failure. A randomised controlled multicentre trial of the effects on knowledge, compliance and quality of life. Patient Educ Couns 2006, 64:128-135.
• [66]Westlake C, Evangelista LS, Strömberg A, Ter-Galstanyan A, Vazirani S, Dracup K: Evaluation of a web-based education and counseling pilot program for older heart failure patients. Prog Cardiovasc Nurs 2007, 22:20-26.
• [67]Gustafson DH, Hawkins R, Boberg E, Pingree S, Serlin RE, Graziano F, Chan CL: Impact of a patient-centered, computer-based health information/support system. Am J Prev Med 1999, 16:1-9.
• [68]Gustafson DH, Hawkins RP, Boberg EW, McTavish F, Owens B, Wise M, Berhe H, Pingree S: CHESS: 10 years research and development in consumer health informatics for broad population, including the underserved. Int J Med Inf 2002, 65:169-177.
• [69]Gustafson DH, Hawkins R, McTavish F, Pingree S, Chen WC, Volrathonchai K, Serlin RC: Internet-based interactive support for cancer patients: are integrated systems better? J Commun 2008, 58:238-257.
• [70]Helwig A, Lovelle A, Guse C, Gottlieb M: An office-based internet patient education system: a pilot system. J Fam Pract 1999, 48:123-127.
• [71]Roberto AJ, Zimmerman RS, Carlyle KE, Abner EL: A computer-based approach to preventing pregnancy, STD, and HIV in rural adolescents. J Health Commun 2007, 12:53-76.
• [72]Tetzlaff L: Consumer informatics in chronic Illness. J Am Med Inform Assoc 1997, 4:285-300.
• [73]Winzelberg A, Eppstein D, Eldredge K, Wilfley D, Dasmahapatra R, Dev P, Taylor C: Effectiveness of an internet-based program for reducing risk factors in eating disorders. J Consult Clin Psychol 2000, 68:346-350.
• [74]"Cyberchondriacs" on the Rise? Those who go online for healthcare information continues to increase. http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId/448/ctl/ReadCustom%20Default/Default.aspx webcite
• [75]Canadian Internet Use Survey. http://www.statcan.gc.ca/daily-quotidien/100510/dq100510a-eng.htm webcite
• [76]Utilisation d’Internet au Québec en novembre 2011 Internet use in Quebec on November 2011. http://blogue.cefrio.qc.ca/2011/11/utilisation-dinternet-au-quebec-en-novembre-2011 webcite
• [77]National Institutes of Health: Grants and funding opportunities. http://grants.nih.gov/grants/oer.htm webcite
• [78]Godin G, Côté J, Naccache H, Lambert LD, Trottier S: Predictors of adherence to antiretroviral therapy: A one year longitudinal study. AIDS Care 2005, 17:493-504.
• [79]Côté J, Godin G, Ramirez P, Gagnon ML, Rouleau G: Program development for enhancing adherence to antiretroviral therapy among persons living with HIV. AIDS Patient Care STDS 2008, 22:965-975.
• [80]Côté J, Ramìrez-Garcia P, Rouleau G, Saulnier D, Guéhéneuc YG, Hernandez A, Godin G: A nursing virtual intervention: Real-time support for managing antiretroviral therapy. Comput Inform Nurs 2011, 29:43-51.
• [81]Bartholomew LK, Parcel GS, Kok G, Gottlieb NH: Intervention Mapping: Designing Theory- and Evidence-Based Health Promotion Programs. Mountain View, CA: Mayfield Publishing Co; 2001.
• [82]Bartholomew LK, Parcel GS, Kok G, Gottlieb NH: Planning Health Promotion Programs: An Intervention Mapping Approach. San Francisco: Jossey-Bass; 2006.
• [83]Bandura A: Self-efficacy: The exercice of control. New York: Freeman; 1997.
• [84]Tuldrà A, Fumaz CR, Ferrer MJ, Bayés R, Arno A, Balagué M, Bonjoch A, Jou A, Negredo E, Parades R, et al.: Prospective randomized two-arm controlled study to determine the efficacy of a specific intervention to improve long-term adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2000, 25:221-228.
• [85]Godin G, Gagné C, Naccache H: Validation of a self-reported questionnaire assessing adherence to antiretroviral medication. AIDS Patient Care STDS 2003, 17:325-332.
• [86]Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodriguez E, Warren MR, Vejo J: Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav 2011, 15:1381-1396.
• [87]Justice AC, Holmes W, Gifford AL, Rabeneck L, Zackin R, Sinclair G, Weissman S, Neidig J, Marcus C, Chesney M, et al.: Development and validation of a self-completed HIV symptom index. J Clin Epidemiol 2001, 54:S77-S90.
• [88]Badia X, Podzamczer D, Garcìa M, López-Lavid C, Consiglio E, Spanish MOS-HIV and MQOL-HIV Validation Group: A randomized study comparing instruments for measuring health-related quality of life in HIV-infected patients. Medical Outcomes Study HIV Health Survey. AIDS 1999, 13:1727-1735.
• [89]Badia X, Podzamcer D, Casado A, López-Lavid C, García M, Spanish MOS-HIV and MQOL-HIV Validation Group: Evaluating changes in health status in HIV-infected patients: Medical Outcomes Study-HIV and Multidimensional Quality of Life-HIV quality of life questionnaires. AIDS 2000, 14:1439-1447.
• [90]Liang K, Zeger S: Longitudinal data analysis using generalized linear models. Biometrics 1986, 7:13-22.
• [91]Bryk A, Raudenbush S, Congdon R: Hierarchical Linear and Nonlinear Modeling With the HLM/2L and HLM/3L programs. Chicago, IL: Scientific Software International; 1996.
• [92]Bennett GG, Glasgow RE: The delivery of public health interventions via the Internet: actualizing their potential. Annu Rev Public Health 2009, 30:273-292.
• [93]Birnbaum MH: Human Research and Data Collection via the Internet. Annu Rev Psychol 2004, 55:803-832.
• [94]Bull S, Lloyd L, Rietmeijer C, McFarlane M: Recruitment and retention of an online sample for an HIV prevention intervention targeting men who have sex with men: the Smart Sex Quest Project. AIDS Care 2004, 16:931-943.
• [95]Nosek BA, Banaji MR: E-Research: Ethics, security, design, and control in Psychological Research on the Internet. J Soc Issues 2002, 58:161-176.
• [96]Smith MA, Leigh B: Virtual subjects: Using the Internet as an alternative source of subjects and research environment. Beh Res Meth 1997, 29:496-505.
• [97]Gosling SD, Vazire S, Srivastava S, John OP: Should we trust web-based studies? Am Psychol 2004, 59:93-104.
• [98]Beddows E: The Methodological Issues Associated with Internet-Based Research. Int J Emerg Tech & Society 2008, 6:124-139.
• [99]Hewson C: Conducting research on the internet. The Psychologist 2003, 16:290-293.
• [100]Michalak EE, Szabo A: Guidelines for Internet Research: An update. Eur Psychol 1998, 3:70-75.
• [101]Paul J, Seib R, Prescott T: The internet and clinical trials: Background, online resources, examples and issues. J Med Internet Res 2005, 7:e5.
• [102]Schubart JR, Stuckey HL, Ganeshamoorthy A, Sciamanna CN: Chronic health conditions and Internet Behavioral Interventions. Comput Inform Nurs 2011, 29:TC9-TC20.
• [103]Bull S, Pratte K, Whitesell N, Rietmeijer C, McFarlane M: Effects of an Internet-based intervention for HIV prevention: the Youthnet trials. AIDS Behav 2009, 13:474-487.