HIV PREVENTION FOR STD CLINIC PATIENTS

描述(申请人提供)：这项研究的长期目标是开发一种可行和有效的艾滋病毒预防策略，用于公共资助的性传播疾病(STD)诊所。尽管去性病诊所就诊的患者感染艾滋病毒的比例高得惊人，但许多人不知道自己的艾滋病毒血清状态，拒绝艾滋病毒检测，对参加更密集的预防计划表现出有限的兴趣。这项拟议的研究将评估以行为科学理论为指导、以激励和技能为特征的两步预防艾滋病毒的方法是否实现了三个重要成果：(A)改善了对艾滋病毒预防服务的参与，(B)减少了危险的性行为，(C)减少了性传播疾病的发生率。在公共资助的大型性病诊所寻求治疗的女性(n=777)和男性(n=777)将被招募并提供知情的书面同意。参与者将在首次就诊时完成一项计算机管理的调查，然后被随机分配到六种干预条件中的一种。这六项干预措施将由一个简短的以临床为基础的部分(两个方面：简要的激励与简要的信息)与随后的强化部分(三个方面：基于技能的与基于信息的与不基于治疗的控制)交叉形成。在完成干预的两个步骤后，患者将在3个月、6个月和12个月的随访中使用观察到的参与艾滋病毒预防服务的数据、自我报告的行为、生物标本和医疗记录进行重新评估。关键的依赖措施包括短期行为结果(同意艾滋病毒检测、返回接受艾滋病毒检测结果、参加强化预防计划)和长期行为和生物结果(性危险行为和性传播疾病发病率)。调查人员预测，短暂的激励部分将增加对艾滋病毒预防服务的参与，而以技能为基础的密集部分将减少危险行为，并导致更少的事故感染。预计接受激励成分的患者将从强化成分中受益最多。拟议的研究涉及一项关键的国家和国际艾滋病毒预防优先事项，即激励高危患者参与艾滋病毒预防服务并从中受益。创新地使用两步法，将激励和行为技能部分结合起来，将推动艾滋病毒预防科学和实践的发展。

DESCRIPTION (provided by applicant): The long-term objective of this research is to develop a feasible and effective HIV prevention strategy for use in publicly funded sexually transmitted disease (STD) clinics. Even though patients attending STD clinics are infected with HIV at alarmingly high rates, many do not know their HIV serostatus, decline HIV testing, and show limited interest in attending more intensive prevention programs. The proposed research will evaluate whether a two-step approach to HIV prevention, which is guided by behavioral science theory and features both motivational and skills components, achieves three important outcomes: (a) improved participation in HIV prevention services, (b) reduced risky sexual practices, and (c) decreased incidence of STDs. Women (n = 777) and men (n = 777) seeking care at a large, publicly-funded STD clinic will be recruited and provide informed written consent. Participants will complete a computer-administered survey at an initial clinic visit, and then will be randomly assigned to one of six intervention conditions. The six interventions will be formed by crossing a brief clinic-based component (two arms: brief motivational vs. brief informational) with a subsequent intensive component (three arms: skills-based vs. information-based vs. no treatment control). After completing both steps of the intervention, patients will be re-assessed at three, 6, and 12-month follow-ups using data obtained from observed participation in HIV prevention services, self-reported behavior, biological specimens, and medical records. Key dependent measures include short-term behavioral outcomes (agreeing to HIV testing, returning for HIV test results, and attending an intensive prevention program) and longer-term behavioral and biological outcomes (sexual risk behavior and incidence of STDs). The investigators predict that the brief motivational component will increase participation in HIV prevention services, and that the intensive skills-based component will reduce risk behavior and lead to fewer incident infections. It is also expected that patients receiving the motivational component will benefit most from the intensive component. The proposed research addresses a critical national and international HIV prevention priority, namely, motivating high-risk patients to engage in, and benefit from, HIV prevention services. The innovative use of a two-step approach, coupling motivational and behavioral skills components, will advance HIV prevention science and practice.