South Africa Options Intervention

SA Options LogoPrincipal Investigators: Jeffrey Fisher, Ph.D.

Co-Investigators: K Rivet Amico, Ph.D., Deborah Cornman, Ph.D., William Fisher, Ph.D., Sandy Pillay, MBChB, Paul Shuper, Ph.D.

Brief overview

Izindlela Zokuphila/Options for Health is a brief, lay counselor delivered intervention designed to reduce sex- related HIV risk behavior among HIV-positive individuals receiving health care in low resource HIV clinical care sites in South Africa.


Adult men and women living with HIV/AIDS and receiving ART medication.

Core components of intervention


Izindlela Zokuphila/Options for Health was adapted from the original Options study completed in HIV care clinics in the USA (Fisher et al., 2004; Fisher et al., 2006). The study was adapted and piloted for South African populations in a 6-month study with 152 HIV-infected patients receiving clinical care at an urban hospital in South Africa that charged modest fees and cared for low income patients. Patients receiving Options counseling were compared to participants receiving standard-of-care control counseling. Patients who received the pilot Options intervention reported a significant decrease over time in number of unprotected sexual events (Cornman et al., 2008).

To develop the current intervention, a second pilot study was conducted with a refined version of the pilot Options intervention. It was implemented by six counselors with 39 patients within the public health system in South Africa where free care is given. The refined intervention was feasible to implement, acceptable to patients and counselors, and implemented with good fidelity (Cornman et al., 2011).

The refined intervention was then delivered in a cluster randomized trial at 16 HIV clinical care sites in KwaZulu Natal. 1891 PLWH on ART were randomized to Options counseling (n = 967) or standard-of-care counseling (n = 924). At an 18-month follow-up assessment, participants receiving the Options intervention reported significantly greater reductions in HIV transmission risk behavior, including sex events with HIV-negative or status unknown partners, than those in the standard-of-care control condition.

The following materials specifically related to the randomized controlled trial and the intervention outcome manuscript are available in support of the South Africa Options Intervention:

Implementation History

The U.S. Options project has been adopted as one of the Centers for Disease Control (CDC) Promising Evidence Interventions. Options has been implemented in New York State, and South Africa Options has been implemented in South Africa (Cornman et al., 2011; Cornman et al., 2008). Variants of the South Africa Options project have been adapted and implemented in a number of other countries in Africa.

Contact info

Jeffrey Fisher, Ph.D.
Institute for Collaboration on Health, Intervention, and Policy
2006 Hillside Rd., U-1248
Storrs, CT 06269
Phone: 860.486.5917

Deborah Cornman, Ph.D.
Institute for Collaboration on Health, Intervention, and Policy
2006 Hillside Rd., U-1248
Storrs, CT 06269
Phone: 860.486.4645