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

摘要 非洲裔美国人和拉丁美洲妇女以及生活在贫困中的妇女， 感染艾滋病毒（CDC，2018）。如果这些妇女有其他危险因素， 艾滋病毒，包括药物使用，亲密伴侣暴力史和无家可归。尽管相对 这些人群的患病率很高，许多具有这些特征的妇女从未接受过检测。 HIV（CDC，2016 a）。了解自己的艾滋病毒状况对于迅速获得治疗和减少艾滋病毒感染至关重要。 艾滋病毒的传播。因此，迫切需要采取有效的干预措施，加强对这些妇女的检测。 强化干预可以有效地增强测试，我们的NIH资助的研究， 加拿大（船体等人，2013年）发现，高风险成人的成功测试率从11%增加到83% 当时，有一种叫。在拟议的项目中，我们将评估一个系统的方法， 加强高危妇女艾滋病毒检测的类似干预措施。我们将培训来自多个国家的约50名员工， 向高危妇女提供服务的社区机构，以鼓励艾滋病毒检测和分娩 加强测试。在对工作人员进行培训后，这些社区机构征聘的334名妇女将 随机接受标准护理转诊程序加降低艾滋病毒风险教育或相同的加 强化，其中他们可以获得高达40美元的完成艾滋病毒检测在研究开始和重复 6个月和12个月后进行测试。主要系统成果将包括工作人员对艾滋病毒的知识和态度 测试和强化干预。主要的客户结果将是接受测试的比例。 探索性分析将评估测试的调节因素，包括诊所、临床医生和客户特征， 以及性风险和其他行为随时间变化的指数和随时间变化的条件。我们还将 估计干预措施的成本及其在促进艾滋病毒检测方面的成本效益。 该项目评估促进艾滋病毒检测的新模式。它开展培训，并提供直接 * 为在下列地点获得服务的妇女提供资源， 药物滥用治疗诊所，联邦合格的健康中心，家庭暴力机构，以及 无家可归者收容所培训涉及系统性和结构性问题，并提供具体方法和 用于增强测试的资源（即，（c）我们的经验整合强化物质使用 通过退伍军人管理局（VA）的治疗直接说明了该项目的潜在成功， 90%的退伍军人事务部诊所在培训后实施了康复者（DePhillipis等人，出版中; Petry等人，2014年a）。由于 这一成功，退伍军人事务部已承诺无限期地支持这一干预。该项目同样提出 最初为艾滋病毒检测者提供假设，如果有效，艾滋病毒检测的成本将是合理的 结果。因此，本项目的结果有可能建立一种高效的方法， 在易受感染的妇女中进行艾滋病毒检测，这可以在全球范围内更容易地应用，以减缓艾滋病毒的传播。

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.