Intervention to Reduce Acute Stress and HIV Risk in Newly HIV Diagnosed Men

减少新确诊艾滋病毒男性的急性压力和艾滋病毒风险的干预措施

• 批准号: 8012114
• 负责人: NATHAN B HANSEN
• 金额: $ 27.29万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-21 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8012114
• 关键词: AIDS prevention; Acute; Address; Affect; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Cognitive; Communities; Development; Diagnosis; Emotional; Enrollment; Event; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health Promotion; Healthcare; Human immunodeficiency virus test; Incidence; Individual; Intervention; Interview; Life; Logistics; Major Depressive Disorder; Manuals; Medical; Mental Health; Meta-Analysis; Methods; Modeling; Motivation; NIH Program Announcements; National Institute of Mental Health; Newly Diagnosed; Outcome; Participant; Patients; Post-Traumatic Stress Disorders; Prevention; Prevention Research; Preventive Intervention; Professional counselor; Provider; Randomized; Reporting; Request for Applications; Research; Review Literature; Risk; Risk Behaviors; Risk Reduction; Sampling; Sex Behavior; Sexual Transmission; Social Work; Staging; Stress; Structure; Suggestion; Techniques; Testing; Training; Translating; Trauma; Writing; acute stress; base; critical period; depressive symptoms; efficacy evaluation; efficacy trial; emotional distress; follow-up; indexing; innovation; meetings; men; men who have sex with men; multidisciplinary; prevent; programs; public health relevance; response; sex risk; skills; statistics; therapy development; time interval; transmission process; treatment as usual

DESCRIPTION (provided by applicant): Problem: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. Additionally, receiving an HIV diagnosis is a traumatic event for many-Over 40% of people living with HIV have posttraumatic stress disorder and as many as 40% these individuals report being diagnosed with HIV as their index trauma. Finally, the first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. Despite these statistics, and CDC's efforts to promote HIV prevention among people living with HIV, few "positive prevention" interventions exist, particularly for MSM. Aims: The proposed research will develop and pilot test an integrated risk reduction intervention for reducing traumatic stress and sexual HIV transmission risk behavior among newly HIV diagnosed men suitable for implementation in the medical care setting by staff commonly available in such settings. The intervention will (1) address the acute stress of receiving an HIV diagnosis to maximize men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis; (2) integrate risk reduction into multidisciplinary care; (3) assist newly diagnosed men in the transition into medical care; and (4) take advantage of the teachable moment presented by the HIV diagnosis to change sexual risk behavior. Methods: Eighty newly HIV diagnosed men (within the previous three months) will be randomly assigned to either: (1) the trauma-focused risk reduction intervention experimental condition, or (2) a usual care comparison condition. Following intervention completion, study providers and participants will be interviewed and logistics evaluated to determine the feasibility and acceptability of the intervention. The following hypotheses will be tested to establish preliminary evaluations of efficacy: (1) Traumatic stress and sexual HIV transmission risk behavior will be reduced across the nine-month study period in the risk reduction intervention condition in relation to the usual care comparison condition, and (2) Depressive symptoms will be reduced and utilization of medical and social services will be increased among newly diagnosed men in the risk reduction intervention condition in relation to the usual care comparison condition. Significance: Positive prevention delivered in the "teachable moment" following an HIV+ diagnosis and seamlessly integrated within medical care will take advantage of a singular window of opportunity to reduce emotional distress and risk behavior, routinize prevention in the care setting, and establish a trajectory of safer sexual behavior for newly diagnosed men. If successful, this research will provide an HIV positive prevention intervention model that can be translated into a sustainable model of care for newly diagnosed MSM, which will meet an urgent need for care programs that identify, treat, and prevent HIV infections. PUBLIC HEALTH RELEVANCE: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. The first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. The proposed research will develop and pilot test an integrated, care-based risk reduction intervention to address the acute stress of receiving an HIV diagnosis to maximize newly diagnosed men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis.

描述（由申请人提供）：问题：估计与男性发生性关系的男性中估计有31,000例新的HIV诊断，代表美国所有新的HIV感染的一半以上（56％），而MSM是唯一发生新艾滋病毒感染发病率越来越多的群体。此外，接受HIV诊断是一个创伤事件，对于40％的艾滋病毒患者患有创伤后应激障碍，这些人报告被诊断为艾滋病毒作为其指数创伤。最后，HIV诊断后的第一年是预防的关键时期，因为在诊断后的3至12个月内，超过50％的新诊断为新诊断的MSM报告HIV传播风险行为。尽管有这些统计数据，以及疾病预防控制中心（CDC）促进HIV患者预防艾滋病毒的努力，几乎没有“积极的预防”干预措施，特别是对于MSM。目的：拟议的研究将开发和进行试验测试，以减少综合风险干预措施，以减少新近艾滋病毒诊断的男性的创伤性压力和性HIV传播风险行为，适用于在此类情况下通常可用的员工在医疗服务中实施的男性。干预将（1）解决接受HIV诊断的急性压力，以最大程度地提高男性参加降低风险和健康促进信息并适应新诊断的能力； （2）将降低风险纳入多学科护理； （3）帮助新诊断的男性过渡到医疗服务； （4）利用艾滋病毒诊断提出的可教会时刻来改变性风险行为。方法：将八十种新的艾滋病毒诊断为男性（在过去的三个月内）将随机分配给：（1）以创伤为中心的风险降低干预实验条件，或（2）通常的护理比较条件。干预完成后，将对研究提供者和参与者进行采访，并评估物流，以确定干预的可行性和可接受性。将测试以下假设以建立疗效的初步评估：（1）在整个九个月的研究期内，创伤性压力和性HIV传播风险行为将在降低风险降低干预条件下减少与通常的护理比较状况有关的风险降低，并且在新的抑郁症状中会增加抑郁症状，以减轻抑郁症状的诊断。比较条件。意义：在艾滋病毒+诊断和无缝整合在医疗服务中的“可教会时刻”中提供的积极预防将利用机会的单一机会窗口来减少情绪困扰和风险行为，在护理环境中例行预防，并确定对新诊断的男性进行更安全的性行为的轨迹。如果成功，这项研究将提供艾滋病毒阳性预防干预模型，可以将其转化为新诊断的已诊断为MSM的可持续护理模型，该模型将满足迫切需要识别，治疗和预防艾滋病毒感染的护理计划。 公共卫生相关性：与男性发生性关系的男性中，估计有31,000次新的HIV诊断，占美国所有新艾滋病毒感染的一半以上（56％），而MSM是唯一具有新艾滋病毒感染发生率的群体。 HIV诊断后的第一年是预防的关键时期，因为超过50％的新诊断为MSM报告诊断后3至12个月内的HIV传播风险行为。拟议的研究将开发和进行试验测试，一种基于护理的综合风险降低干预措施，以解决接受HIV诊断的急性压力，以最大程度地提高新诊断的男性参加降低风险和健康促进信息并适应新诊断的能力。