HIV PREVENTION FOR STD CLINIC PATIENTS

描述（由申请人提供）：这项研究的长期目标是制定一个可行和有效的艾滋病预防策略，用于公共资助的性传播疾病（STD）诊所。尽管在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抗体状况，拒绝接受艾滋病毒检测，并且对参加更深入的预防项目兴趣有限。这项拟议的研究将评估以行为科学理论为指导，以动机和技能为特征的两步走艾滋病预防方法是否取得了三个重要成果：(a)提高了艾滋病预防服务的参与度，(b)减少了危险的性行为，(c)降低了性病的发病率。在大型公共资助的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书。参与者将在初次就诊时完成一项计算机管理的调查，然后将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基于临床的组成部分（两组：简短的动机与简短的信息）与随后的强化组成部分（三组：基于技能的、基于信息的、无治疗控制的）交叉构成。在完成干预的两个步骤后，患者将在3个月、6个月和12个月的随访中重新评估，使用从观察到的参与艾滋病毒预防服务、自我报告行为、生物标本和医疗记录中获得的数据。关键的依赖措施包括短期行为结果（同意HIV检测，返回HIV检测结果，参加强化预防项目）和长期行为和生物学结果（性风险行为和性传播疾病的发生率）。研究人员预测，简短的动机部分将增加对艾滋病毒预防服务的参与，而密集的基于技能的部分将减少风险行为并导致更少的意外感染。预计接受动机成分的患者将从强化成分中获益最多。拟议的研究解决了一个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。创新性地使用两步走方法，将动机和行为技能组成部分结合起来，将促进艾滋病毒预防科学和实践。

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.