Implementation, Effectiveness, and Cost-Effectiveness of an HIV Intervention

HIV 干预措施的实施、有效性和成本效益

基本信息

批准号：
8011637
负责人：
Jill Owczarzak
金额：
$ 57.74万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-30 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8011637
关键词：
AIDS prevention Address Affect African American Age Attention Attitude Be++ element Behavior Therapy Beryllium Centers for Disease Control and Prevention (U.S.)Characteristics Client Coitus Communication Counseling Development Diffusion Economics Education Effectiveness Effectiveness of Interventions Elements Enrollment Ethics Ethnic Origin Evaluation Evidence based intervention Expectancy Funding Gender Goals HIV HIV Infections Human Incentives Intervention Intervention Studies Interview Investments Knowledge Leadership Mediating Methods Mission Modeling Modification NIH Program Announcements Outcome Participant Patient Self-Report Preventive Intervention Process Provider Public Health Quality-Adjusted Life Years Questionnaires Race Randomized Randomized Controlled Trials Research Resources Risk Risk Behaviors Risk Reduction Self Efficacy Services Sex Behavior Sexual Partners Site Source Structure Testing Time Training Transcript Treatment Efficacy United States National Institutes of Health Videotape Woman base behavior change community based service condoms consistent condom use cost cost effectiveness design effective intervention effectiveness research efficacy trial empowered evidence base follow up assessment follow-up group intervention intervention program peer post intervention prevention service programs provider intervention psychosocial public health relevance randomized trial research study response satisfaction sex risk staff intervention theories volunteer

项目摘要

DESCRIPTION (provided by applicant): Two decades of carefully-controlled randomized trials have established that sexual behavior change interventions can significantly reduce intervention participants' risk of acquiring HIV. There is abundant scientific evidence of the efficacy of these interventions when conducted in research settings with well-trained staff, sometimes substantial participant incentives, and the economic, human, and organizational resources that typify NIH-funded intervention research centers. However, the effectiveness of these interventions when implemented by frontline HIV prevention service providers is largely unknown. When implementing an evidence-based intervention, frontline service providers are apt to modify the original intervention in ways that best suit the organization's available resources, goals, and limitations. How these various factors influence the effectiveness of research-based interventions when implemented in the "real world" has received very limited attention. Based on the strength of evidence provided by randomized, controlled efficacy trials, the Centers for Disease Control and Prevention (CDC) has compiled a compendium of efficacious, evidence-based HIV prevention interventions. However, it is not known whether these interventions are effective when implemented in the real-world, by resource-constrained service providers; how these service providers adapt research- based interventions and how these modifications affect intervention effectiveness; how organizational, structural, and client-centered factors impact the ability of frontline service providers to effectively implement these interventions; or whether these interventions are cost-effective when implemented by frontline service providers. To address these critical research questions, the proposed study will evaluate the effectiveness and cost-effectiveness of DiClemente and Wingood's SISTA intervention for African American women, as implemented by 8 HIV prevention service providers that have completed the CDC's DEBI training for the SISTA intervention. The main analysis will assess the effectiveness and cost-effectiveness of the SISTA intervention as implemented by each of the service providers, and overall, across service providers. A mixed method (quantitative/qualitative) approach will be utilized to characterize intervention implementation, to study intervention adaptation processes, and to assess how service provider characteristics influence intervention fidelity and effectiveness. PUBLIC HEALTH RELEVANCE: The proposed study addresses a highly-significant question of great public health importance: Are evidence- based HIV prevention interventions effective when implemented by frontline service providers? NIH's substantial investment in the development of efficacious interventions comes to naught if these interventions cannot be effectively implemented by frontline HIV prevention service providers.

描述（由申请人提供）：二十年精心对照的随机试验已经证实，性行为改变干预措施可以显着降低干预参与者感染艾滋病毒的风险。有大量的科学证据表明，当在研究环境中进行这些干预措施时，这些干预措施是有效的，并且有训练有素的工作人员，有时还有大量的参与者激励措施，以及 NIH 资助的干预研究中心典型的经济、人力和组织资源。然而，一线艾滋病毒预防服务提供者实施这些干预措施的有效性在很大程度上尚不清楚。在实施基于证据的干预措施时，一线服务提供者倾向于以最适合组织可用资源、目标和限制的方式修改原始干预措施。这些不同的因素如何影响基于研究的干预措施在“现实世界”中实施时的有效性，受到的关注非常有限。根据随机对照疗效试验提供的证据强度，美国疾病控制与预防中心 (CDC) 编制了一份有效、循证的艾滋病毒预防干预措施纲要。然而，尚不清楚这些干预措施在现实世界中由资源有限的服务提供商实施时是否有效；这些服务提供者如何调整基于研究的干预措施以及这些修改如何影响干预措施的有效性；组织、结构和以客户为中心的因素如何影响一线服务提供商有效实施这些干预措施的能力；或者这些干预措施由一线服务提供商实施时是否具有成本效益。为了解决这些关键的研究问题，拟议的研究将评估 DiClemente 和 Wingood 对非裔美国妇女的 SISTA 干预措施的有效性和成本效益，该干预措施由 8 名已完成 CDC 的 SISTA 干预 DEBI 培训的艾滋病毒预防服务提供者实施。主要分析将评估每个服务提供商以及整个服务提供商实施的 SISTA 干预措施的有效性和成本效益。将采用混合方法（定量/定性）方法来描述干预实施的特征，研究干预适应过程，并评估服务提供者特征如何影响干预保真度和有效性。公共卫生相关性：拟议的研究解决了一个对公共卫生具有重大意义的重要问题：一线服务提供者实施的基于证据的艾滋病毒预防干预措施是否有效？如果一线艾滋病毒预防服务提供者不能有效实施这些干预措施，NIH 在开发有效干预措施方面的大量投资就会化为泡影。