PHYSICIAN DELIVERED INTERVENTION FOR HIV+ INDIVIDUALS

关于减少HIV+人群中的HIV风险行为，我们所知相对较少，尽管事实上，在HIV+人群中已经记录了高水平的此类行为，尽管事实上，为HIV+人群制定有效的降低风险干预措施已被确定为NIH的首要任务。迫切需要设计有效的干预措施，以减少艾滋病毒阳性者中的高危行为，因为实施危险行为的艾滋病毒阳性者是未感染性伴侣和共用针头伴侣的艾滋病毒风险的某些来源，并可能将耐药的艾滋病毒株和其他病原体传播给艾滋病毒阳性伴侣，并且他们本身容易与其他病原体合并感染（例如，性传播疾病）通过高风险行为。此外，减少艾滋病毒阳性者的高危行为在当前的高效抗逆转录病毒疗法（HAART）时代尤为重要。因为HAART可以大大增加HIV+人群的健康和寿命，它也提供了在很长一段时间内将HIV传播给他人的可能性，因此可以增强抗逆转录病毒疗法抗性菌株的传播（例如，AZT，3 TC，可能还有HAART）。拟议的研究应用信息-动机-行为技能（IMB）模型的艾滋病毒风险行为的变化，设计一个医生提供的干预，以减少艾滋病毒阳性成年男子和妇女接受艾滋病毒治疗环境中的艾滋病毒风险行为。艾滋病毒的标准治疗需要定期和频繁地访问临床护理机构，往往导致密切的病人-临床医生关系。因此，这种环境是对艾滋病毒阳性个体进行预防干预的一个极其有力的背景。该研究将在两家非常相似的艾滋病毒诊所进行，这些诊所总共治疗了1800多名艾滋病毒+成年人。一个诊所将作为干预部位，另一个诊所作为对照部位。干预措施将由一组经验丰富的行为科学家和艾滋病毒临床研究人员设计和实施。该研究计划的总体目标是设计、实施和严格评估一种基于概念、易于传播、临床医生提供的干预措施，以促进在艾滋病毒治疗环境中接受护理的艾滋病毒阳性成年人降低艾滋病毒风险。这一人群面临着将艾滋病毒传染给其他艾滋病毒感染者以及自身感染其他病原体的巨大风险，而且对这一人群几乎没有任何有效的减少艾滋病毒风险干预措施。

Relatively little is known about reducing HIV risk behavior among HIV+ persons, despite the fact that high levels of such behavior have been documented within the HIV+ population, and despite the fact that development of effective risk reduction interventions for HIV+ persons has been identified as a top NIH priority. The need to design effective interventions to reduce high risk behaviors among HIV+ individuals is pressing, since HIV+ persons who practice risky behaviors are certain sources of HIV risk to uninfected sexual and needle-sharing partners, and may transmit treatment resistant strains of HIV and other pathogens to HIV+ partners, and are themselves vulnerable to coinfection with other pathogens (e.g., STDs) through high risk behavior. Moreover, reducing high risk behavior among HIV+ persons is especially critical in the current era of highly active antiretroviral therapy (HAART). Because HAART may result in greatly increased health and lifespan for HIV+ persons, it also affords the possibility of transmitting HIV to others over greatly extended periods of time and may therefore enhance transmission of strains resistant to antiretroviral therapies (e.g., AZT, 3TC, and possibly HAART). The proposed research applies the Information--Motivation--Behavioral Skills (IMB) model of HIV risk behavior change to design a physician- delivered intervention to reduce HIV risk behavior among HIV+ adult men and women receiving care in HIV treatment settings. Standard treatment for HIV necessitates regular and frequent visits to clinical care settings, often resulting in close patient-clinician relationships. Thus, this setting is an exceedingly powerful context for prevention interventions for HIV+ individuals. The study will be conducted at two very comparable HIV clinics which together treat over 1800 HIV+ adults. On clinic will serve as an intervention site and one as a control site. The intervention will be designed and conducted by an experienced group of behavioral scientists and HIV clinical researchers. The overall goal of this program of research is to design, to implement, and to rigorously evaluate a conceptually based, easily disseminated, clinician- delivered intervention to promote HIV risk reduction among HIV+ adults receiving care in HIV treatment settings. This population is at enormous risk for transmitting HIV to others who are HIV-, and for acquiring other pathogens themselves and it is a population for whom there are few if any effective HIV risk reduction interventions.