Prevention among HIV+ Crack Users in the Hospital

描述(由申请人提供)：艾滋病毒预防信息通常针对未感染的、处于危险中的个人，并侧重于预防感染艾滋病毒。最近，艾滋病毒预防领域的一种转变认识到为艾滋病毒阳性个人制定干预战略的重要性，因为每一次新感染都是从已经感染艾滋病毒的人开始的。先前的研究表明，许多艾滋病毒阳性的人继续从事不安全的危险行为，而吸食可卡因与这些危险行为显著相关。这些数据还表明，吸毒与初级门诊艾滋病毒护理的使用呈负相关。医院或住院病房可能是向艾滋病毒阳性的高危吸毒者提供预防干预的重要但在很大程度上尚未开发的环境。医院还为感染强效吸毒者的艾滋病毒预防干预提供了一个重要的环境，因为住院可能是患者接受行为改变干预的“可教时刻”。 我们在迈阿密大学和埃默里大学之间的多地点研究将在佛罗里达州迈阿密的杰克逊纪念医院和佐治亚州亚特兰大的格雷迪纪念医院进行。我们将对从杰克逊和格雷迪医院的HIV住院病房招募的HIV阳性强效吸毒者进行简短的、理论指导的“预防护理倡导者”干预的有效性进行评估。我们将提供多组成部分的技能建设干预措施，鼓励参与者倡导为他们自己和他们的同龄人预防和接受初级保健服务。这些干预策略是从疾控中心资助的多点研究中最近开发和测试的策略改编而来的。我们将采用随机实验设计，将干预的效果与注意控制组进行比较。参与者将在基线以及完成干预后的6个月和12个月进行评估。这项研究的主要结果将是减少无保护措施的性行为。次要成果将包括增加艾滋病毒初级门诊车的使用，以及增加药物治疗的准备和进入。

DESCRIPTION (provided by applicant): HIV prevention messages have typically targeted uninfected, at-risk individuals and have focused on forestalling the acquisition of HIV. Recently, a shift in the HIV prevention field has recognized the importance of developing intervention strategies for HIV-positive individuals, since each new infection begins with someone who is already HIV-infected. Prior studies show that many HIV-positive individuals are continuing to engage in unsafe risk behaviors and that crack use is significantly associated with these risk behaviors. These data also show that crack use is negatively associated with the use of primary outpatient HIV care. The hospital or inpatient ward may be an important, yet largely untapped setting to provide prevention interventions to high-risk, HIV-positive crack users. Hospitals also provide an important setting for HIV prevention interventions with infected crack users, because hospitalization may serve as a "teachable moment" when patients are open to behavioral change interventions. Our multi-site study between the University of Miami and Emory University will be conducted at Jackson Memorial Hospital in Miami, Florida and Grady Memorial Hospital in Atlanta, Georgia. We will evaluate the efficacy of a brief, theoretically-guided, "Prevention Care Advocate" intervention with HIV-positive crack users recruited from the HIV inpatient hospital wards at Jackson and Grady hospitals. We will provide a multicomponent, skills-building intervention that encourages participants to advocate for prevention and receipt of primary care services for themselves and their peers. These intervention strategies are adapted from strategies recently developed and tested in previous CDC-funded multi-site studies. We will employ a randomized experimental design to compare the intervention's efficacy with an attention-control group. Participants will be assessed at baseline and 6 and 12 months after completing the intervention. The primary outcome of the study will be to reduce unprotected sex. Secondary outcomes will include increasing the use of HIV primary outpatient cars and increasing readiness for and entry to drug treatment.