Repeat STI Patients: Tailored Socio-Contextual Intervention to Reduce HIV Risk

重复性传播感染患者：量身定制的社会情境干预措施可降低艾滋病毒风险

• 批准号: 8518470
• 负责人: Lance S Weinhardt
• 金额: $ 53.95万
• 依托单位: UNIVERSITY OF WISCONSIN MILWAUKEE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-24 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8518470
• 关键词: AIDS prevention; Address; Affective; African American; Alcohol or Other Drugs use; Area; Caring; Case Management; Case Manager; Chlamydia; Cities; Clinic; Clinic Visits; Communities; Complex; Control Groups; Cost Effectiveness Analysis; Data; Diagnosis; Domestic Violence; Economically Deprived Population; Electronics; Elements; Employment; Enrollment; Ensure; Epidemic; Exposure to; Face; Funding; Future; Gonorrhea; HIV; HIV Infections; HIV risk; Health; Health Services Accessibility; Health system; Housing; Human immunodeficiency virus test; Incidence; Individual; Infection; Infection prevention; Intervention; Intervention Studies; Intervention Trial; Interview; Lead; Literature; Low income; Maintenance; Measures; Mediator of activation protein; Mental Depression; Modeling; Outcome; Pamphlets; Participant; Partner Notification; Patients; Phase; Population; Poverty; Prevalence; Prevention; Preventive Intervention; Problem Solving; Program Evaluation; Protocols documentation; Public Health; Publishing; Quality of life; Randomized; Randomized Clinical Trials; Recruitment Activity; Relative (related person); Reporting; Request for Applications; Research; Research Project Grants; Resources; Risk; Risk Behaviors; Risk Reduction; Sampling; Schedule; Services; Sexually Transmitted Diseases; Site; Social Environment; Social Work; Structure; Substance abuse problem; Sum; Syphilis; System; Telephone; Testing; Time; Trichomonas Infections; Unemployment; Visit; Wisconsin; Woman; Work; base; computerized; contextual factors; cost; cost effective; cost effectiveness; design; effective intervention; efficacy testing; experience; follow-up; group intervention; high risk; high risk sexual behavior; intervention effect; men; novel; prevention service; public health relevance; screening; sex risk; skills; social; standard care; standard of care; theories; transmission process

DESCRIPTION (provided by applicant): Repeat sexually transmitted infections (STI), such as Chlamydia, gonorrhea, trichomoniasis, and syphilis indicate persistent elevated risk activity for HIV, and repeated STI infections increase the likelihood of HIV transmission during exposure. Repeat STI patients represent a significant proportion of public STI clinic visits. Patients who seek treatment for repeat STI infections, by definition, are not adequately served by the prevention services currently provided by STI clinics, and may benefit from additional clinic-based services to reduce their risk of future infections of STI and HIV. The HIV prevention field has largely been silent about assisting repeat STI patients; there are no published studies testing interventions specifically for this population. In addition, most HIV risk-reduction intervention research based in STI clinics has focused directly on the presenting problem of sexual risk behavior, at most addressing one other related factor, such as co- existing depression or substance use, in a single study, whereas it is clear that repeat STI is driven by a wide range of contextual factors. Novel, individually tailored intervention approaches are likely needed to help repeat STI patients reduce their risk of HIV infection and infecting others. We propose to address these limitations of previous research by developing and testing an individually-tailored strengths-based prevention case management intervention strategy based on Social Action Theory (Ewart, 1991) that addresses repeat STI patients' social context and other factors that heighten STI and HIV risk among these patients. This research will be conducted in two phases. During the first 12-15 months of the project, our efforts will be devoted to conducting formative research on the phenomenon of repeat STI in Milwaukee, WI, a city with high and rising rates of STI, and on developing and piloting the intervention protocol. Our formative work will consist of three major elements. First we will conduct qualitative interviews with a sample of repeat STI patients to better understand the factors that lead to their repeated infection and what services they believe could help them avoid future infections. Second, we will develop an individually tailored clinic-based intervention to reduce risk among repeat STI patients. Third, we will conduct a feasibility and acceptability trial of the intervention. In the second phase of the project, we will conduct a full randomized clinical trial with 250 men and 250 women attending the clinic with two or more STI in a 12 month period. We will follow participants in the experimental group and the control group (clinic standard care) for 12 months following recruitment to examine the effects of the intervention on sexual risk activity, repeat STI, and other beneficial health effects. Finally, we will conduct a cost and cost-effectiveness analysis of the intervention. PUBLIC HEALTH RELEVANCE: We propose to develop an intervention that will reduce the potential for HIV infection and other health risks among patients with repeat sexually transmitted infections. We expect that the planned intervention will also have broader positive effects on patients' social context, ability to plan for the future, and quality of life, which may result in positive health effects in other areas as well. By developing an individualized intervention to help these patients to reduce their exposure to infection with HIV and other STIs we expect the intervention could be used in many US STI clinics to reduce the burden of STI and risk for HIV among these patients, their partners, and health systems.

描述（由申请人提供）：重复的性传播感染（STI），例如衣原体、淋病、滴虫病和梅毒，表明 HIV 的风险活动持续升高，并且重复的 STI 感染会增加暴露期间 HIV 传播的可能性。重复性传播感染患者在公共性传播感染诊所就诊的患者中占很大比例。根据定义，寻求重复性传播感染治疗的患者目前无法获得性传播感染诊所目前提供的预防服务的充分服务，并且可能会受益于额外的基于诊所的服务，以降低他们未来感染性传播感染和艾滋病毒的风险。艾滋病毒预防领域在很大程度上对帮助复发性传播感染患者保持沉默。目前还没有已发表的研究专门测试针对这一人群的干预措施。此外，大多数基于性传播感染诊所的艾滋病毒风险降低干预研究都直接关注当前的性危险行为问题，最多在一项研究中解决一个其他相关因素，例如共存的抑郁症或药物滥用，而很明显，重复性传播感染是由多种背景因素驱动的。可能需要新颖的、个性化的干预方法来帮助重复感染性传播感染的患者降低感染艾滋病毒和感染他人的风险。我们建议通过开发和测试基于社会行动理论（Ewart，1991）的个性化定制的基于优势的预防病例管理干预策略来解决先前研究的这些局限性，该策略解决重复性传播感染患者的社会背景和其他加剧性传播感染和传播的因素。这些患者中存在艾滋病毒风险。这项研究将分两个阶段进行。在该项目的前 12-15 个月内，我们将致力于对威斯康星州密尔沃基（性传播感染发病率较高且不断上升的城市）的重复性传播感染现象进行形成性研究，并致力于制定和试点干预方案。我们的形成性工作将包括三个主要要素。首先，我们将对反复感染性传播感染的患者样本进行定性访谈，以更好地了解导致他们反复感染的因素以及他们认为哪些服务可以帮助他们避免未来感染。其次，我们将制定个性化的基于临床的干预措施，以降低重复性传播感染患者的风险。第三，我们将对干预措施进行可行性和可接受性试验。在该项目的第二阶段，我们将进行一项全面的随机临床试验，招募 250 名男性和 250 名女性在 12 个月内就诊，患有两次或以上性传播感染。我们将在招募后跟踪实验组和对照组（诊所标准护理）的参与者 12 个月，以检查干预措施对性风险活动、重复性传播感染和其他有益健康影响的影响。最后，我们将对干预措施进行成本和成本效益分析。 公共卫生相关性：我们建议制定一项干预措施，以减少重复性传播感染患者感染艾滋病毒和其他健康风险的可能性。我们预计计划的干预措施还将对患者的社会背景、规划未来的能力和生活质量产生更广泛的积极影响，这也可能对其他领域的健康产生积极影响。通过制定个性化干预措施来帮助这些患者减少感染艾滋病毒和其他性传播感染的机会，我们预计该干预措施可以在美国许多性传播感染诊所中使用，以减轻这些患者、其伴侣及其伴侣的性传播感染负担和感染艾滋病毒的风险。卫生系统。