Health Related Interventions For Persons Living With HIV

描述（由申请人提供）：预防艾滋病毒感染者（PLH）是国家的重要优先事项（CDC, 2001）。通过在4个城市（纽约市、洛杉矶、旧金山和华盛顿州）开展首个多地点随机对照预防试验，旨在减少艾滋病病毒相关传播行为。次要目标是帮助PLH保持积极的应对方式和心理健康，并加强卫生保健行为。干预设计和评估是通过对152名PLH的定性研究、与提供者的焦点小组和招聘地点的观察得出的。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，在15次会议中交付：1)压力，应对和调整，以提高PLH的生活质量；2)风险行为，减少传播行为；健康行为可能增加个人的长期生存前景和减少病毒载量。在评估3819例PLH后，943例近期有传播行为并符合资格标准的成年PLH被随机分为立即干预组（n=469）或滞后状态组（n= 474），并每5个月（基线、5、10、15、20和25个月）进行纵向随访，随访率为70%-87%。样本具有种族多样性（45%为非裔美国人，15%为拉丁裔），由来自多个亚群体的PLH组成（57%为男同性恋者，21%为女性，11%为注射吸毒者），并具有高风险背景（49%为监狱，14%为无家可归者，63%为吸毒成瘾者）。每个干预模块的出勤率在56% - 90%之间。我们要求延长2年的资金，以便：1)完成数据收集（2003年8月至2004年5月期间，342名PLH处于滞后状态的662项评估和干预）；2)完整的数据分析（包括每个PLH在4个时间点的所有病毒载量分析）。由于筛查不可行（可靠性、敏感性和特异性较低；Wight等人，2000年），需要进行全面评估以确定是否合格，有传播行为的PLH发生率低于预期（28%对66%），需要更多的招募地点。这项试验的结果将为HRSA和CDC的治疗指南提供信息，并可能为在治疗和社区环境中提供预防服务提供一种模式。我们不仅能够评估项目在主要和次要结果、成本和成本效益方面的有效性，我们还能够检查变化的预测因素并确定实施的障碍。

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.