A Reinforcement Intervention for Increasing HIV Testing Among At-Risk Women

加强高危女性艾滋病毒检测的强化干预措施

基本信息

批准号：
10402255
负责人：
Kristyn Zajac
金额：
$ 53.41万
依托单位：
UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10402255
关键词：
Address Adult African American Attitude Behavior Behavioral Canada Caring Centers for Disease Control and Prevention (U.S.)Characteristics Client Clinic Clinical Communities Contracts Domestic Violence Education Funding HIV HIV Infections HIV risk Health Services Accessibility Health behavior High Prevalence High Risk Woman Homelessness Housing Human immunodeficiency virus test Institutes Intervention Knowledge Latina Medical Methods Modeling Outcome Persons Population Poverty Prevalence Procedures Provider Psychological reinforcement Public Health Randomized Recording of previous events Reporting Resources Risk Risk Behaviors Risk Factors Risk Reduction Self Efficacy Services Sexually Transmitted Diseases Substance Use Disorder Supervision System Testing Time Time Study Training United States Department of Veterans Affairs United States National Institutes of Health Veterans Woman Women&apos s Health Work base behavioral economics burden of illness community setting cost cost effectiveness cost estimate effective intervention effectiveness evaluation efficacy evaluation experience food insecurity health care quality health disparity health disparity populations health literacy high risk high risk sexual behavior homeless shelters improved improved outcome indexing intervention cost intimate partner violence intravenous drug use novel programs racial discrimination recruit referral services reinforcer secondary outcome service delivery socioeconomic disparity standard care substance abuse treatment substance use substance use treatment success theories tool

项目摘要

Abstract African American and Latina women, as well as women living in poverty, are at disproportionate risk for contracting HIV (CDC, 2018). Prevalence is increased further in these women if they have other risk factors for HIV, including substance use, history of intimate partner violence, and homelessness. Despite the relatively high prevalence rates in these populations, many women with these characteristics have never been tested for HIV (CDC, 2016a). Knowledge of one’s HIV status is crucial for rapid access to treatment and reducing the spread of HIV. Thus, effective interventions for enhancing testing in these women are an imminent need. Reinforcement interventions can be efficacious in enhancing testing, and our NIH-funded study in Canada (Hull et al., 2013) found that rates of successful testing in high risk adults increased from 11% to 83% when reinforcers were provided. In the proposed project, we will evaluate a systems approach applying a similar intervention for enhancing HIV testing in high risk women. We will train ~50 staff from multiple community agencies that provide services to high risk women to encourage HIV testing and deliver reinforcement for testing. After staff training, 334 women recruited at these community agencies will be randomized to standard care referral procedures plus HIV risk reduction education or the same plus reinforcement, in which they can receive up to $40 for completing HIV testing at study initiation and for repeat testing 6 and 12 months later. Primary systems outcomes will include staff knowledge and attitudes about HIV testing and reinforcement interventions. The primary client outcome will be proportions who undergo testing. Exploratory analyses will evaluate moderators of testing, including clinic, clinician, and client characteristics, as well as indices of change in sexual risk and other behaviors over time and by condition over time. We will also estimate costs of the intervention and its cost effectiveness in promoting HIV testing. This project evaluates new models to promote HIV testing. It institutes trainings and provides direct resources for integrating reinforcement-based HIV testing referral procedures to women accessing services at substance abuse treatment clinics, Federally Qualified Heath Centers, domestic violence agencies, and homeless shelters. Trainings address systemic and structural issues and provide concrete methods and resources to enhance testing (i.e., reinforcers). Our experiences integrating reinforcement for substance use treatment through the Veterans Administration (VA) speak directly to this project’s potential success, with over 90% of VA clinics implementing reinforcers after training (DePhillipis et al., in press; Petry et al., 2014a). Due to this success, the VA has committed to supporting this intervention indefinitely. This project likewise proposes to initially provide reinforcers with the presumption that, if effective, costs will be justified by HIV testing outcomes. Thus, results from this project hold the potential to establish a highly effective method to increase HIV testing in vulnerable women, which could be readily applied more globally to slow the spread of HIV.

抽象的非裔美国人和拉丁裔妇女以及生活在贫困中的妇女的风险不成比例艾滋病毒（CDC，2018年）。如果这些女性还有其他风险因素，则会进一步提高艾滋病毒，包括药物使用，亲密伴侣暴力历史和无家可归。尽管有亲戚在这些人群中，许多具有这些特征的女性从未进行过测试艾滋病毒（CDC，2016a）。了解一个人的艾滋病毒状况对于快速获得治疗和减少治疗至关重要艾滋病毒的传播。这是迫在眉睫的有效干预措施，以增强这些妇女的测试。加强干预措施可以有效地增强测试，而我们的NIH资助加拿大（Hull等，2013）发现，高风险成年人成功测试的比率从11％增加到83％提供增强剂时。在拟议的项目中，我们将评估采用应用程序的系统方法类似的干预措施，以增强高风险女性的艾滋病毒测试。我们将培训大约50名员工为高风险妇女提供服务以鼓励艾滋病毒测试和分娩的社区机构用于测试的强化。经过员工培训，在这些社区机构招募的334名妇女将是随机分配到标准护理转诊程序以及降低艾滋病毒风险教育或相同的Plus 强化，在研究计划中完成艾滋病毒测试的最高可收到40美元，并重复在6个月和12个月后进行测试。主要系统成果将包括员工知识并参加有关艾滋病毒的知识测试和加强干预措施。主要客户结果将是接受测试的比例。探索性分析将评估测试的主持人，包括诊所，临床和客户特征，作为随着时间的流逝，随着时间的流逝，性风险和其他行为的变化指标。我们也会估计干预措施的成本及其在促进艾滋病毒测试方面的成本效益。该项目评估了促进艾滋病毒测试的新模型。它提出了培训并提供直接将基于强化的艾滋病毒测试转介程序整合给妇女获取服务的资源药物滥用治疗诊所，联邦合格的卫生中心，家庭暴力机构和无家可归的庇护所。培训解决了系统和结构性问题，并提供具体的方法和增强测试的资源（即增强剂）。我们整合使用物质使用的强化的经验通过退伍军人管理（VA）的治疗直接谈到了该项目的潜在成功，并结束训练后，有90％的VA诊所实施了增强剂（Dephillipis等人，印刷中； Petry等，2014a）。由于这项成功，弗吉尼亚州已致力于无限期地支持这项干预措施。这个项目同样提议最初为增援部队提供这样的假设，即如果有效，艾滋病毒测试将是合理的结果。该项目的结果有可能建立一种高效的方法来增加弱势妇女的艾滋病毒测试，可以在全球范围内更容易应用以减缓艾滋病毒的传播。