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

• 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
• 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' 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

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.

摘要 非洲裔美国人和拉丁裔妇女以及生活在贫困中的妇女面临着不成比例的风险 感染艾滋病毒(疾控中心，2018年)。如果这些妇女有其他危险因素，她们的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。尽管相对来说 在这些人群中的高患病率，许多具有这些特征的妇女从未接受过检测 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加强测试，我们由美国国立卫生研究院资助的研究 加拿大(Hull等人，2013)发现，高危成年人的检测成功率从11%上升到83% 当提供增强剂的时候。在建议的项目中，我们将使用 加强高危妇女艾滋病毒检测的类似干预措施。我们将从多个部门培训约50名员工 向高危妇女提供服务以鼓励艾滋病毒检测和接生的社区机构 加固以进行测试。经过工作人员培训后，这些社区机构将招聘334名妇女 随机到标准护理转诊程序加上艾滋病毒风险降低教育或相同的加 强化，他们可以获得高达40美元的资金，用于在研究开始时完成艾滋病毒检测和重复研究 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 测试和加固干预措施。客户的主要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，包括临床、临床医生和客户特征，如 以及性风险和其他行为随时间和条件随时间的变化的指数。我们还将 估计干预的成本及其在促进艾滋病毒检测方面的成本效益。 该项目评估了促进艾滋病毒检测的新模型。IT机构提供培训，并直接提供 将以强化为基础的艾滋病毒检测转介程序整合到妇女获得服务的资源 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 用于加强测试的资源(即增强剂)。我们将增强剂整合为物质使用的经验 通过退伍军人管理局(VA)进行的治疗直接关系到该项目的潜在成功， 90%的退伍军人管理局诊所在培训后实施增强剂(DePhillipis等人，正在出版；Peter等人，2014a)。由于 这一成功，退伍军人管理局承诺无限期地支持这一干预。该项目同样提出了 最初向增强者提供的推定是，如果有效，艾滋病毒检测将证明成本是合理的 结果。因此，这一项目的结果有可能建立一种高效的方法来提高 在弱势妇女中进行艾滋病毒检测，这可以更容易地在全球范围内应用，以减缓艾滋病毒的传播。