PROJ 1: UPR: 3 COHORTS OF WOMEN AT RISK OF HIV

项目 1：普遍定期审议：3 个面临艾滋病毒风险的女性群体

• 批准号: 7380870
• 负责人: ROSIMAR TORRES
• 金额: $ 16.88万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7380870
• 关键词: PROJ; UPR; COHORTS; WOMEN; RISK

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Specific Aims and Results 1.0 To translate, validate, and culturally adapt the RESPECT-2 which is an HIV prevention intervention developed by the Centers for Disease Control (CDC) that incorporates the rapid HIV test as part of the model. 2.0 To pilot the intervention in women from each of the 3 groups: (women who are street sex workers and/or crack users, women referred with a sexually transmitted infection and women attending family planning clinics). (20 women per group, N=60) 3.0 Characterize the three groups as to: sociodemographic, economic, general health, and lifestyles, sexual practices, history of childhood abuse, domestic violence, and health believes. 4.0 To determine HIV, Gonorrhea, and Chlamydia prevalence in the three cohorts. 5.0 To determine HIV, Gonorrhea, and Chlamydia incidences in the three Significance This study uses the HIV rapid test. This type of testing is a new technology; therefore, developing and testing interventions that incorporate this tool into current practices is essential. Along with this type of testing comes a rapid counseling which includes a pre and post counseling at the same session. Existing interventions provide the framework and experience for the application to specific minority populations; however, culturally adapting instruments is essential to ensure effectiveness. Many behavioral interventions or counseling to reduce HIV risk have proven to be effective in diverse populations. The RESPECT-2 intervention, developed by the CDC for English speaking populations, was translated into Spanish and culturally adapted to the Puerto Rican population. The RESPECT-2 uses the rapid HIV test to reduce the time and number of visits. Oftentimes original instruments or interventions are discarded after cultural adaptation and result in an entirely new intervention, derived from the past adaptation experiences. Studies employing only a translated intervention, which is not culturally adapted, will not reflect the true realities of the targeted minority populations. The resulting new and adapted intervention will be studied and if effective, then it can be disseminated within the groups working on preventive interventions with populations similar to the ones studied. Results: All objectives regarding the translation and cultural adaptation have been accomplished. A new rapid HIV counseling intervention was developed from this preliminary work. The validation of the intervention initiated with the pilot intervention of 20 participants from each site. This will continue during the next year of the study which will recruit 90 participants per year, for 3 years, this leading to a total of 270 participants. The study originally intended to translate and culturally adapt the RESPECT-2, an HIV counseling intervention from the Center of Disease Control (CDC). After the translation of the intervention module, focus groups were conducted among women from three risk behavior groups: street sex workers/crack users, STD clinics, and family planning clinics in Puerto Rico. The participants found the translated RESPECT-2 insensitive regarding sexuality and sexual topics. Participants considered the questions repetitive, disorganized, disrespectful, and time allocated to sensible topics was limiting. Several terms were confusing, ambiguous, and unclear. These factors negatively influenced the empathy between the counselor and the participant. These responses and reactions were attributed to cultural differences. Consequently, a new version of the intervention module was developed, taking into consideration the language, sensibility, education level, and lifestyles of the three study groups. Two amendments were sent to the IRB. One was to modify the type of HIV testing; from a blood test to an oral test and to include the use of Chlamydia and Gonorrhea urine tests. This amendment was approved on September 2005. The second amendment was to modify the amount of participants from ten participants per site to twenty. This amendment was approved on March 2006. As of June 25, 2006, a total of 56 participants have been recruited. Of these, 20 where from the family planning clinic, 18 from the STD clinic, and 18 from the CBO. A total of 44 follow up visits have been attended. From these, 16 where from the family planning clinic, 14 from the STD clinic, and 14 from the CBO. The participants have expressed the need for additional informative materials about sexual toy hygiene, sexually transmitted disease, drugs, and local health and legal service areas. The study staff has created brochures on these topics to attend the participant¿s needs. Meetings with the study staff, advisors and Director of the PR-CCHD were conducted to modify the study in view of the finding of the preliminary phase. The new phase includes a total of ninety participants per year, thirty from each site. There will be a longer follow up in the participants (from one year to eighteen months). This decision was based on a previous study conducted at the Maternal Infant Studies Center (2005) which suggested the need for a longer study period to monitor STD risk reduction behaviors. This study observed a decrease between the risk behaviors in the first twelve months and a reappearance of the risk behaviors when monitored on the 18th month. Preliminary Results Most of the participants were in a consensual relationship (30.4%) with high school education (51.7%). The most frequent age range was 20-29 (n=20). Forty participants (71%) reported alcohol consumption and 31 (55.4%) reported cigarette use. The majority reported a preference for having sex with someone form the opposite gender (89.3%). The participants mean age at their first sexual experience was 17 years while the first sexual partner¿s mean age was 21 years of age. Moreover, 6 participants reported been forced to perform sexual acts at least once in their life (mean age 19 years old).

该子项目是利用 NIH/NCRR 资助的中心拨款提供的资源的众多研究子项目之一，该子项目和研究者 (PI) 可能已从其他 NIH 来源获得主要资助，因此可以在其他 CRISP 机构中得到体现。列出的是中心，不一定是研究者的机构 具体目标和结果 1.0 翻译、验证并在文化上适应 RESPECT-2，这是由疾病控制中心 (CDC) 开发的艾滋病毒预防干预措施。 2.0 将快速艾滋病毒检测作为模型的一部分，对以下 3 组妇女进行试点干预：（街头性工作者和/或吸毒者的妇女、患有性传播感染的妇女和照顾家庭的妇女）。 （每组 20 名女性，N=60） 3.0 描述三个群体的特征：社会人口、经济、一般健康和生活方式、性行为、儿童虐待史、家庭暴力和健康信念 4.0 至。确定三个队列中的艾滋病毒、淋病和衣原体患病率 5.0 确定三个队列中的艾滋病毒、淋病和衣原体发病率 意义 本研究使用艾滋病毒快速检测，因此，开发和测试干预措施。将这一工具纳入当前的实践中是必不可少的，同时进行快速咨询，其中包括在同一会议上进行的咨询前和咨询后，为应用于特定少数群体提供了框架和经验；然而，适应文化的工具对于确保有效性至关重要。许多降低艾滋病毒风险的行为干预或咨询已被证明对不同人群有效。CDC 为英语人群开发的 RESPECT-2 干预措施已被翻译成西班牙语和文化。 RESPECT-2 使用快速 HIV 检测来减少就诊时间和次数。在文化适应后，原始仪器或干预措施通常会被丢弃，并根据过去的适应经验产生全新的干预措施。仅使用翻译的研究不适应文化的干预措施将无法反映目标少数群体的真实情况，将对由此产生的新的和适应的干预措施进行研究，如果有效，则可以在针对类似群体的预防性干预措施的小组内进行传播。结果：有关翻译和文化适应的所有目标均已完成，该初步工作已由每个地点的 20 名参与者开始进行干预验证。在下一年的研究中，将招募每年 90 名参与者，持续 3 年，最终共有 270 名参与者参与该研究，最初的目的是对 RESPECT-2（疾病控制中心 (CDC) 的艾滋病毒咨询干预措施）进行翻译和文化调整。在干预模块中，焦点小组在来自三个危险行为群体的妇女中进行：波多黎各的街头性工作者/性病使用者、性传播疾病诊所和计划生育诊所。参与者发现翻译后的 RESPECT-2 对性行为和性话题不敏感。认为问题重复、杂乱、不尊重，并且分配给合理主题的时间有限。这些因素对辅导员和参与者之间的同理心产生了负面影响。考虑到三个研究组的语言、敏感性、教育水平和生活方式，开发了新版本的干预模块，并向IRB发送了两项修正案，其中一项是修改了血液检测的类型。进行口语测试和包括使用衣原体和淋病尿液检测。该修正案于 2005 年 9 月获得批准。第二次修正案是将每个地点的参与者数量从 10 名修改为 2006 年 3 月。截至 6 月 25 日， 2006 年，总共招募了 56 名参与者，其中 20 名来自计划生育诊所，18 名来自性病诊所，18 名来自 CBO。参加了 44 次随访，其中 16 次来自计划生育诊所，14 次来自性病诊所，14 次来自 CBO。参与者表示需要有关性玩具卫生、性传播疾病、研究人员制作了有关这些主题的小册子以供参与者参加。根据初步阶段的发现，与研究人员、顾问和 PR-CCHD 主任举行了会议，以修改研究。新阶段每年共有 90 名参与者，每个地点 30 名。将对参与者进行更长时间的随访（从一年到十八个月）。这一决定是基于母婴研究中心（2005）之前进行的一项研究，该研究表明需要更长的研究期来监测性病风险。这项研究观察到了减少行为。前 12 个月的危险行为与第 18 个月监测时危险行为的再现之间存在差异。 初步结果 大多数参与者 (30.4%) 与高中教育程度 (51.7%) 存在共识。范围为 20-29 (n=20)。 40 名参与者 (71%) 报告饮酒，31 名参与者 (55.4%) 报告吸烟。与异性发生性关系（89.3%），参与者第一次性经历的平均年龄是 17 岁，而第一个性伴侣的年龄是 17 岁。此外，6 名参与者报告称，他们一生中至少被迫进行过一次性行为（平均年龄 19 岁）。