Reducing HIV risk behavior in depressed and non-depressed older adults with HIV

减少患有艾滋病毒的抑郁和非抑郁老年人的艾滋病毒风险行为

• 批准号: 9237171
• 负责人: Travis Ian Lovejoy
• 金额: $ 54.22万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-15 至 2020-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9237171
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adult; Advertisements; Age; Age-Years; Alcohol or Other Drugs use; Anus; Attention; Attitude; Behavior Therapy; Behavioral; Belief; Characteristics; Client; Communities; Comorbidity; Data; Depressed mood; Educational Intervention; Effectiveness; Elderly; Eligibility Determination; Enrollment; Ensure; Ethnic Origin; Future; Gender; Geography; HIV; HIV Seropositivity; HIV risk; Individual; Intervention; Intervention Trial; Journals; Knowledge; Mediation; Mediator of activation protein; Mental Depression; Mental Health; Neurocognition; Neurocognitive; Neurocognitive Deficit; Newly Diagnosed; Outcome; Participant; Persons; Population; Preparation; Preventive Intervention; Protocols documentation; Provider; Public Health; Questionnaires; Race; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Regimen; Reporting; Risk; Risk Behaviors; Rural; Sampling; Secondary Prevention; Self-Administered; Services; Severities; Sex Behavior; Sexual Health; Sexual Partners; Social Work; Telephone; Telephone Interviews; Testing; Therapeutic; Training; Travel; Treatment Efficacy; United States; Vagina; Viral Load result; Work; age related; antiretroviral therapy; base; clinical care; condoms; coping; depressive symptoms; effectiveness clinical trial; efficacy testing; evidence base; flexibility; follow-up; improved; innovation; motivational enhancement therapy; person centered; physical conditioning; practice-based research network; pre-exposure prophylaxis; prevention service; primary outcome; psychiatric symptom; psychosocial; public health relevance; racial and ethnic; racial diversity; scale up; secondary outcome; sex; sexual HIV transmission; sexual relationship; sexually active; skills; skills training; social stigma; theories; transmission process; treatment as usual; web site

 DESCRIPTION (provided by applicant): By 2020, 70% of people living with HIV in the United States will be ≥50 years of age due, in large part, to improved clinical care, more efficacious antiretroviral therapy regimens, and the increasing number of persons newly diagnosed with HIV ≥50 years of age. An estimated 37% of sexually active older people living with HIV (OPLWH) continue to engage in HIV transmission sexual behaviors. In spite of repeated calls for secondary prevention interventions to reduce condomless sex in OPLWH, no age-appropriate, evidence-based secondary prevention interventions exist for this group. Many OPLWH cannot engage in face-to-face secondary prevention services because of HIV- and age-related stigma, comorbid mental and physical health conditions that complicate travel to venues in which HIV prevention interventions are delivered, or geographic isolation. High rates of depression and neurocognitive impairment in OPLWH may further complicate engagement in, and reduce benefits of, interventions that aim to reduce HIV transmissions in this group. The proposed study is a randomized controlled trial of a 5-session telephone-administered motivational interviewing plus behavioral skills training (teleMI+BST) intervention to reduce condomless sex in HIV-positive adults 50-plus years of age. A geographically and ethnically/racially diverse sample of 336 OPLWH will be recruited across the U.S. through community-based organizations that serve people living with HIV, rural networks of HIV social service providers, advertisements placed in HIV-related magazines and websites, and online dating forums. Eligible persons will be randomly assigned to receive either a 5-session teleMI+BST intervention or an attention equivalent 5-session telephone-administered coping effectiveness training (teleCET) control intervention. Study therapists will be community-based HIV social service providers located in Portland, OR. Self- administered questionnaires will assess demographic characteristics, and condom use knowledge, beliefs, attitudes, and skills, while a brief telephone interview will assess sexual behavior, substance use, and psychiatric symptoms. A telephone-administered neurocognitive assessment will also be conducted at baseline. Study Aim 1 will test the efficacy of teleMI+BST to reduce occasions of non-condom protected anal and vaginal intercourse with HIV-negative or unknown HIV serostatus partners and examine psychosocial mediators of intervention efficacy. Study Aim 2 will test the efficacy of teleMI+BST to reduce depressive symptoms in mildly depressed participants. Study Aim 3 will test the moderating effect of baseline depressive symptom severity on teleMI+BST efficacy. Additional exploratory analyses will examine the impact of neurocognitive functioning, VL, and pre-exposure prophylaxis (PrEP) use by participants' sexual partners on teleMI+BST efficacy. This study may yield an evidence-based, person-centered intervention that meets the unique sexual relationship and health needs of OPLWH and reduces the transmission of HIV to their HIV- negative sexual partners.

 描述（由适用提供）：到2020年，在美国，有70％的艾滋病毒患者在很大程度上归因于50岁，这在很大程度上是由于临床护理的改善，更有效的抗逆转录病毒治疗方案以及刚诊断为HIV≥50岁的新人数量的增加。估计有37％的性活跃的艾滋病毒（OPLWH）的性活跃老年人继续从事艾滋病毒传播性行为。尽管反复呼吁采取继发性预防干预措施以减少OPLWH中的无避孕套性别，但该组没有适合年龄的，基于证据的二级预防干预措施。由于HIV和年龄相关的污名，合并的心理和身体健康状况，许多OPLWH无法从事面对面的二级预防服务，这使您前往提供HIV预防干预措施或地理隔离的场所。 OPLWH中抑郁症和神经认知障碍的高率可能会进一步使参与的互动并降低旨在减少该组HIV传播的干预措施的益处。拟议的研究是一项随机对照试验，该试验是5条电话管理的动机访谈加行为技能培训（Telemi+BST）的干预措施，以减少50岁以上HIV阳性成年人的无避孕套性别。在美国，将通过社区组织招募336个OPLWH的地理和种族多样性的样本，这些组织将为拥有艾滋病毒的人们，艾滋病毒社会服务提供者的粗糙网络，与HIV相关的杂志和网站上放置的广告以及在线约会论坛上的广告。合格的人将被随机分配接受5节的Telemi+BST干预措施或同等的5条电话管理的应对效率培训（TELECET）控制干预措施。学习治疗师将是位于俄勒冈州波特兰市的社区艾滋病毒社会服务提供者。自我管理的问卷将评估人口特征，并使用避孕套知识，信仰，吸引力和技能，而短暂的电话采访将评估性行为，药物使用和精神病症状。基线还将进行电话管理的神经认知评估。研究目标1将测试Telemi+BST的有效性，以减少与HIV阴性或未知的HIV HIV血清伴侣的非核对肛门和阴道性交的场合，并检查干预有效性的心理社会介体。研究目标2将测试Telemi+BST的有效性，以减少轻度抑郁参与者的抑郁症状。研究目标3将测试基线抑郁症状严重程度对TELEMI+BST有效的调节作用。其他探索性分析将检查参与者的性伴侣对TELEMI+BST有效性的神经认知功能，VL和暴露前预防（PREP）的影响。这项研究可能会产生基于循证的，以人为本的干预措施，以满足OPLWH的独特性关系和健康需求，并减少HIV向其艾滋病毒负面性伴侣的传播。