Brief Care-based HIV Prevention for Newly Diagnosed Men

针对新诊断男性的简要护理型艾滋病毒预防

基本信息

批准号：
7862343
负责人：
KATHLEEN J SIKKEMA
金额：
$ 71.75万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-06-08 至 2012-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7862343
关键词：
AIDS prevention AIDS/HIV problem Address Alcohol or Other Drugs use Anus Behavioral Caring Case Management Clinic Communities Community Health Centers Diagnosis Elements Enrollment Epidemic Evidence based intervention Exhibits Frequencies HIV HIV Infections HIV Seropositivity HIV diagnosis Health Promotion Human immunodeficiency virus test Individual Intervention Intervention Studies Intervention Trial Knowledge Learning Maintenance Mediation Mediator of activation protein Medical Mental Health Services Modeling Motivation Newly Diagnosed Nurses Outcome Participant Patients Persons Physicians Prevention Preventive Intervention Primary Health Care Professional counselor Public Health Randomized Relative (related person)Reporting Request for Applications Research Risk Risk Behaviors Risk Reduction Risk Reduction Behavior Sex Behavior Sexual Transmission Sexually Transmitted Diseases Testing Time Translating Unsafe Sex Visit base behavior change behavior influence brief intervention catalyst critical period effective intervention follow-up interdisciplinary approach intervention effect meetings men men who have sex with men post intervention prevent primary care setting programs prospective psychosocial public health relevance randomized trial sex risk sexually active skills standard care standard of care transmission process uptake

项目摘要

DESCRIPTION (provided by applicant): Recent increases in HIV diagnoses, sexually transmitted infections, and risk behavior indicate that research is needed to identify effective positive prevention interventions integrated within HIV primary care settings to reduce transmission risk behavior among HIV positive individuals. In particular, no effective interventions exist for those newly diagnosed. The time period after HIV diagnosis may be a `teachable moment' to motivate reductions in risk behavior or maintenance of lower risk. This is a window of opportunity, as the first year after receiving an HIV diagnosis may be a critical period for risk reduction, especially for men. The primary objective of this study is to evaluate the efficacy of a brief positive prevention intervention, based on the Information, Motivation and Behavioral Skills (IMB) Model, provided within the care and treatment of newly diagnosed HIV-positive men who have sex with men (MSM) to reduce transmission risk behavior. The proposed five-year study will randomly assign 300 sexually active, HIV- positive MSM, newly diagnosed within the prior 3 months, to receive either 1) comprehensive standard of care (CSC) or 2) Brief Risk Reduction + CSC (BRR), a brief individual intervention based on the IMB model that addresses sexual transmission risk behavior and substance use. BRR will follow the initial physician visit and integrate risk reduction in the context of personalized and relevant medical treatment to enhance the uptake of health-protective information. Assessments of information, motivational influences, behavioral skills, sexual risk behavior, and substance use will be collected at baseline, post-intervention (3-), and 6-, 9-, 12- month follow-up points to determine intervention outcome effects. It is hypothesized that, relative to newly diagnosed HIV- positive men assigned to the comparison condition (CSC), those in the BRR intervention will exhibit significantly lower rates of HIV sexual transmission risk behavior, delayed onset to first unprotected sexual activity, and reduced substance use. Over time, reductions in transmission risk behaviors will be predicted by key elements of the IMB model and will demonstrate mediation of intervention effects. If successful, this research will identify a brief positive prevention intervention that can be implemented in the care setting for newly HIV diagnosed men. PUBLIC HEALTH RELEVANCE Research is needed to identify effective positive prevention interventions that can be integrated within HIV treatment settings to reduce risk behavior among HIV positive individuals. This research will be the first to evaluate a brief risk reduction intervention to reduce transmission risk behavior among newly HIV diagnosed men, with scientific relevance regarding whether intervening early after an HIV+ diagnosis maximizes a `teachable moment' for risk reduction. The proposed intervention research is significant and highly relevant to the public health, due primarily to the importance of targeting those newly diagnosed. Intervening early after the HIV diagnosis focuses on a time period that may have increased likelihood of HIV transmission due to fluctuating levels of risk behavior as one adjusts to the diagnosis, provides an opportunity to maintain risk reduction initiated after learning of HIV+ status, and assists in the transition to medical care through inclusion of risk reduction in a multidisciplinary approach to care.

描述（由申请人提供）：最近增加了艾滋病毒诊断，性传播感染和风险行为，表明需要进行研究以识别在HIV初级保健环境中集成的有效阳性预防干预措施，以减少HIV阳性个人的传播风险行为。特别是，新诊断的人没有有效的干预措施。艾滋病毒诊断后的时间段可能是一个“可教的时刻”，以激发风险行为的降低或降低风险的维持。这是一个机会之窗，因为接受HIV诊断的第一年可能是降低风险的关键时期，尤其是对于男性而言。这项研究的主要目的是根据信息，动机和行为技能（IMB）模型评估短暂的预防干预措施的功效，该模型在护理和治疗新诊断的新诊断的HIV阳性男性（MSM）以减少传播风险行为的疗效。拟议的五年研究将随机分配300个性活跃的HIV-正阳性MSM，在前3个月内新诊断为新诊断，以接受1）全面的护理标准（CSC）或2）简短的风险降低 + CSC（BRR），这是一种基于IMB模型的简短个人干预，该模型解决了性传播风险行为和物质的使用。 BRR将遵循最初的医师访问，并在个性化和相关的医疗治疗的背景下整合降低风险，以增强健康保护信息的吸收。将在基线，干预后（3-）和6个，9个，9个月12个月的随访点上收集信息，动机影响，行为技巧，性风险行为和吸毒的评估，以确定干预结果效应。假设，相对于分配给比较条件（CSC）的新诊断的HIV阳性男性，BRR干预中的人将表现出明显较低的HIV性传播风险行为，延迟发作至首次未经保护的性活动，并减少了药物使用。随着时间的流逝，IMB模型的关键要素将预测传播风险行为的减少，并将证明干预效果的中介。如果成功，这项研究将确定可以在新近艾滋病毒诊断的男性的护理环境中实施的简短预防干预措施。需要进行公共卫生相关性研究以确定可以在艾滋病毒治疗环境中纳入的有效预防干预措施，以减少艾滋病毒阳性人群的风险行为。这项研究将是第一个评估短暂的降低风险干预措施，以减少新艾滋病毒诊断的男性的传播风险行为，并具有有关在HIV+诊断后早期介入是否介绍的科学意义，以最大程度地减少风险降低风险。拟议的干预研究主要是针对新诊断的人的重要性，与公共卫生非常重要，并且与公共卫生高度相关。艾滋病毒诊断后的早期介入的重点是由于风险行为的波动程度而导致艾滋病毒传播的可能性增加，因为人们可以适应诊断，提供了一个机会，为了解HIV+状态后开始降低风险的机会，并有助于通过降低医疗护理的过渡，通过将风险降低纳入多学科的方法来培养。