BOSTON DEMONSTRATION OF OUTREACH FOR AIDS PREVENTION

这项提案寻求为波士顿的一个地块开发提供资金， 展示和评估全面的 社区外展模式预防艾滋病毒在 没有接受治疗的静脉注射吸毒者。建议的波士顿模式 寻求向静脉毒瘾治疗的所有主要部门派遣外展工作人员 人口，发展更高效的行为改变 干预措施，协调所有现有的与艾滋病有关的资源和 为静脉吸毒人员提供服务，并进行一项流行病学调查 抗体状况，以更有效地针对外展工作和 推动社区变革。外展将延伸到街道 吸毒者，性伴侣，中产阶级吸毒者，吸毒者妓女， 恢复IVDU，IVDU在医疗和罪犯中的 司法系统和静脉注射吸毒者正在寻求从 作为这个项目的一部分，专门为他们设立的场地。在……上面 根据之前的研究，私家侦探认为，在 这一次是为了强化 外展模式。因此，当地的评价设计将 随机分配波士顿的16个地区(按种族和 与艾滋病毒感染率匹配)符合以下标准 行为改变干预或强化干预 加上密集的后续咨询或永久性的艾滋病- 预防社区组织者向标准外展 包裹。对干预措施有效性的估计将 源于基线和后续访谈和抗体检测 与1000名静脉注射吸毒者(每个地区65人)的队列 干预前抗体阴性。还将有一个 主要基于人种学的地方过程评估 观察、访谈和服务利用情况。外展 员工还将进行基线和后续面谈，作为 对国家成果进行评估。以前的经验是非常 巴尔的摩的类似研究使研究团队能够设计 干预级别，避免评估设计陷阱和 预见外展实施中的问题。

This proposal seeks funds for a Boston site to develop, demonstrate and evaluate the effectiveness of a comprehensive community outreach model to prevent the spread of HIV among IVDU's who are not in treatment. The proposed model for Boston seeks to send outreach workers to all major segments of the IVDU population, develop more highly effective behavior-change interventions, coordinate all existing AIDS-related resources and services for IVDU's, and conduct an epidemilogical survey of antibody status to target the outreach more effectively and motivate community change. The outreach will be to street IVDU's, sex-partners, middle class IVDU's, IVDU prostitutes, recovering IVDU'S, IVDU'S in the medical care and criminal justice systems and IVDU'S who are seeking antibody testing from a site specially established for them as part of this project. On the basis of prior research, the P.I. believes that a great need at this time is to intensify the behavior-change component of the outreach model. The local evaluation design will therefore randomly assign 16 areas of Boston (stratified by ethnicity and matched on the rate of HIV infection) to either the standard behavior change intervention or an enhanced intervention that adds wither intensive follow-up counseling or a permanent AIDS- prevention community organizer to the standard outreach package. Estimates of the effectiveness of the interventions will stem from baseline and followup interviews and antibody testing with a cohort of 1000 IVDU's (65 from each area) who were antibody negative before the intervention. There will also be a local process evaluation based primarily on ethnographic observation, interviews and utilization of services. The outreach workers will also conduct baseline and followup interviews as part of a national outcome evaluation. Prior experience in a very similar study in Baltimore has allowed the study team to design the intervention levels, avoid evaluation design pitfalls and anticipate problems of outreach implementation.