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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：
10152378
负责人：
Kristyn Zajac
金额：
$ 55.18万
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 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10152378
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 Inequality Institutes Intervention Knowledge Latina Medical Methods Modeling Outcome 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 Structure 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 socioeconomics 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.

抽象的非裔美国和拉丁裔妇女以及生活贫困的妇女面临着不成比例的风险感染艾滋病毒（CDC，2018）。如果这些女性有其他危险因素，患病率会进一步增加艾滋病毒，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女性从未接受过检测艾滋病毒（CDC，2016a）。了解自己的艾滋病毒状况对于快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来加强这些女性的检测。强化干预措施可以有效地增强测试，我们的 NIH 资助的研究加拿大（Hull et al., 2013）发现高危成人的检测成功率从 11% 增加到 83% 当提供强化物时。在拟议的项目中，我们将评估应用系统方法类似的干预措施可加强高危女性的艾滋病毒检测。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以鼓励艾滋病毒检测和提供服务的社区机构用于测试的加固。经过员工培训后，这些社区机构招募的 334 名女性将随机接受标准护理转诊程序加艾滋病毒风险降低教育或相同加强化，在研究开始时完成 HIV 检测以及重复检测后，他们可以获得高达 40 美元的奖励 6个月和12个月后进行测试。主要系统成果将包括员工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的变化以及随时间的状况变化的指数。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型。它开展培训并提供直接将基于强化的艾滋病毒检测转介程序整合到获得服务的妇女的资源药物滥用治疗诊所、联邦合格健康中心、家庭暴力机构，以及无家可归者收容所。培训解决系统性和结构性问题并提供具体方法和加强测试的资源（即强化物）。我们在强化物质使用方面的经验退伍军人管理局 (VA) 的治疗直接说明了该项目的潜在成功，超过 90% 的 VA 诊所在培训后实施强化措施（DePhillipis 等人，出版中；Petry 等人，2014a）。由于鉴于这一成功，退伍军人事务部承诺无限期支持这项干预措施。该项目同样提出最初提供强化措施的假设是，如果有效，艾滋病毒检测将证明成本合理结果。因此，该项目的结果有可能建立一种高效的方法来增加对弱势女性进行艾滋病毒检测，可以在全球范围内广泛应用，以减缓艾滋病毒的传播。