Health Related Interventions For Persons Living With HIV

针对艾滋病毒感染者的健康相关干预措施

• 批准号: 6787192
• 负责人: ANKE A. EHRHARDT
• 金额: $ 17.5万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-09-30 至 2005-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6787192
• 关键词: AIDS; AIDS education /prevention; HIV infections; behavior modification; behavioral /social science research tag; clinical research; clinical trials; cognitive behavior therapy; communicable disease control; cooperative study; coping; data collection methodology /evaluation; health behavior; high risk behavior /lifestyle; human subject; human therapy evaluation; longitudinal human study; mental health; outcomes research; sex behavior; statistics /biometry; substance abuse related disorder

DESCRIPTION (provided by applicant): Prevention for Persons Living with HIV (PLH) is a critical national priority (CDC, 2001). This is addressed by conducting the first multi-site randomized controlled prevention trial aimed at reducing HIV-related transmission acts among PLH in 4 cities (NYC, LA, SF, & MW). Secondary goals are to assist PLH to maintain positive coping styles & mental health & to enhance health care behaviors. The intervention design & the assessments were informed by qualitative studies with 152 PLH, focus groups with providers, & observations in recruitment sites. Based on these results & Social Action Theory (Ewart, 1991), a 3 module intervention was designed to be delivered over 15 sessions: 1) Stress, Coping, & Adjustment to enhance PLH's quality of life; 2) Risk Behaviors to reduce transmission acts; & 3) Health Behaviors that may increase individuals' prospects for long-term survival & decrease viral loads. After assessing 3819 PLH, 943 adult PLH who had engaged in recent transmission acts & met eligibility criteria were randomized to an Immediate Intervention (n=469) or Lagged Condition (n = 474) & have been followed longitudinally at 5 month intervals (baseline, 5, 10, 15, 20, & 25 months), with 70%-87% follow-up rates across assessments. The sample is ethnically diverse (45% African American, 15% Latino), composed of PLH from multiple subgroups (57%, MSM; 21%, women; 11%, IDU), & with high-risk backgrounds (49% jail, 14% recently homeless; 63% hard drug use). Attendance at each intervention module ranges from 56% - 90%. We are requesting extended funding for 2 years in order to: 1) complete data collection (662 assessments & interventions with 342 PLH in the Lagged Condition from 8/03- 5/04); & 2) complete data analysis (including analysis of all viral loads from each PLH at 4 time points). Extended recruitment was required because screening was not feasible (low reliability, sensitivity, & specificity; Wight et al., 2000) & full assessments were required to determine eligibility, the rate of PLH with transmission acts was lower than anticipated (28% vs. 66%), & more recruitment sites were needed. The results of this trial will inform treatment guidelines for both HRSA & the CDC, as well as potentially provide a model for delivery of prevention services in treatment & community-based settings. Not only will we be able to evaluate the program's efficacy on primary & secondary outcomes, cost, & cost-effectiveness, we will also be able to examine predictors of change & to identify barriers to implementation.

描述（由申请人提供）： 预防艾滋病毒感染者是国家的一个重要优先事项（疾病预防控制中心，2001年）。这是通过进行第一个多地点随机对照预防试验，旨在减少艾滋病毒相关的传播行为之间的PLH在4个城市（纽约市，洛杉矶，旧金山，和MW）。次要目标是帮助PLH保持积极的应对方式和心理健康，并加强医疗保健行为。干预设计和评估是通过对152名PLH的定性研究，与供应商的焦点小组以及招募地点的观察而进行的。基于这些结果和社会行动理论（Ewart，1991），设计了一个3模块的干预措施，在15个会议上进行：1）压力，应对和调整，以提高PLH的生活质量; 2）风险行为，以减少传播行为; 3）健康行为，可能会增加个人的长期生存前景和减少病毒载量。在评估了3819例PLH后，将943例最近有过传播行为并符合资格标准的成人PLH随机分为立即干预组（n=469）或滞后状态组（n = 474），并以5个月的间隔（基线，5，10，15，20和25个月）进行纵向随访，各评估的随访率为70%-87%。样本是种族多样的（45%非裔美国人，15%拉丁美洲人），由来自多个亚组的PLH组成（57%，MSM; 21%，女性; 11%，IDU），并具有高风险背景（49%监狱，14%最近无家可归; 63%硬毒品使用）。每个干预单元的出勤率为56% -90%。 我们要求延长2年的资金，以便：1）完成数据收集（从8/03- 5/04，对342名处于滞后状态的PLH进行662次评估和干预）; 2）完成数据分析（包括分析每个PLH在4个时间点的所有病毒载量）。需要扩大招募，因为筛查不可行（可靠性、敏感性和特异性低; Wight等人，2000年），需要进行全面评估以确定合格性，有传播行为的艾滋病毒携带者的比例低于预期（28%对66%），需要更多的招募地点。这项试验的结果将为HRSA和CDC提供治疗指南，并可能为在治疗和社区环境中提供预防服务提供模式。我们不仅能够评估该计划在主要和次要结果，成本和成本效益方面的有效性，我们还将能够检查变化的预测因素并确定实施障碍。