Intervention to Reduce Acute Stress and HIV Risk in Newly HIV Diagnosed Men

减少新确诊艾滋病毒男性的急性压力和艾滋病毒风险的干预措施

• 批准号: 8012114
• 负责人: NATHAN B HANSEN
• 金额: $ 27.29万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-21 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8012114
• 关键词: AIDS prevention; Acute; Address; Affect; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Cognitive; Communities; Development; Diagnosis; Emotional; Enrollment; Event; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health Promotion; Healthcare; Human immunodeficiency virus test; Incidence; Individual; Intervention; Interview; Life; Logistics; Major Depressive Disorder; Manuals; Medical; Mental Health; Meta-Analysis; Methods; Modeling; Motivation; NIH Program Announcements; National Institute of Mental Health; Newly Diagnosed; Outcome; Participant; Patients; Post-Traumatic Stress Disorders; Prevention; Prevention Research; Preventive Intervention; Professional counselor; Provider; Randomized; Reporting; Request for Applications; Research; Review Literature; Risk; Risk Behaviors; Risk Reduction; Sampling; Sex Behavior; Sexual Transmission; Social Work; Staging; Stress; Structure; Suggestion; Techniques; Testing; Training; Translating; Trauma; Writing; acute stress; base; critical period; depressive symptoms; efficacy evaluation; efficacy trial; emotional distress; follow-up; indexing; innovation; meetings; men; men who have sex with men; multidisciplinary; prevent; programs; public health relevance; response; sex risk; skills; statistics; therapy development; time interval; transmission process; treatment as usual

DESCRIPTION (provided by applicant): Problem: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. Additionally, receiving an HIV diagnosis is a traumatic event for many-Over 40% of people living with HIV have posttraumatic stress disorder and as many as 40% these individuals report being diagnosed with HIV as their index trauma. Finally, the first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. Despite these statistics, and CDC's efforts to promote HIV prevention among people living with HIV, few "positive prevention" interventions exist, particularly for MSM. Aims: The proposed research will develop and pilot test an integrated risk reduction intervention for reducing traumatic stress and sexual HIV transmission risk behavior among newly HIV diagnosed men suitable for implementation in the medical care setting by staff commonly available in such settings. The intervention will (1) address the acute stress of receiving an HIV diagnosis to maximize men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis; (2) integrate risk reduction into multidisciplinary care; (3) assist newly diagnosed men in the transition into medical care; and (4) take advantage of the teachable moment presented by the HIV diagnosis to change sexual risk behavior. Methods: Eighty newly HIV diagnosed men (within the previous three months) will be randomly assigned to either: (1) the trauma-focused risk reduction intervention experimental condition, or (2) a usual care comparison condition. Following intervention completion, study providers and participants will be interviewed and logistics evaluated to determine the feasibility and acceptability of the intervention. The following hypotheses will be tested to establish preliminary evaluations of efficacy: (1) Traumatic stress and sexual HIV transmission risk behavior will be reduced across the nine-month study period in the risk reduction intervention condition in relation to the usual care comparison condition, and (2) Depressive symptoms will be reduced and utilization of medical and social services will be increased among newly diagnosed men in the risk reduction intervention condition in relation to the usual care comparison condition. Significance: Positive prevention delivered in the "teachable moment" following an HIV+ diagnosis and seamlessly integrated within medical care will take advantage of a singular window of opportunity to reduce emotional distress and risk behavior, routinize prevention in the care setting, and establish a trajectory of safer sexual behavior for newly diagnosed men. If successful, this research will provide an HIV positive prevention intervention model that can be translated into a sustainable model of care for newly diagnosed MSM, which will meet an urgent need for care programs that identify, treat, and prevent HIV infections. PUBLIC HEALTH RELEVANCE: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. The first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. The proposed research will develop and pilot test an integrated, care-based risk reduction intervention to address the acute stress of receiving an HIV diagnosis to maximize newly diagnosed men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis.

描述（由申请人提供）：问题：估计每年有31,000例新的艾滋病毒诊断发生在男男性行为者（MSM）中，占美国所有新的艾滋病毒感染的一半以上（56%），和男男性行为者是唯一一个新的艾滋病毒感染率上升的群体。此外，接受艾滋病毒诊断对许多人来说是一个创伤性事件-超过40%的艾滋病毒感染者患有创伤后应激障碍，多达40%的这些人报告被诊断为艾滋病毒作为他们的索引创伤。最后，艾滋病毒诊断后的第一年是预防的关键时期，因为超过50%的新诊断的男男性行为者在诊断后3至12个月内报告了艾滋病毒传播风险行为。尽管有这些统计数据，疾病预防控制中心也努力在艾滋病毒感染者中促进艾滋病毒预防，但几乎没有“积极预防”干预措施，特别是对男男性行为者。目的：拟议的研究将开发和试点测试一个综合的风险降低干预措施，以减少创伤压力和艾滋病毒性传播风险行为的新诊断的艾滋病毒的男子适合在医疗保健环境中实施的工作人员通常在这种设置。干预措施将：（1）解决接受艾滋病毒诊断的严重压力，以最大限度地提高男子关注减少风险和健康宣传信息的能力，并适应新的诊断;（2）将减少风险纳入多学科护理;（3）协助新诊断的男子过渡到医疗护理;（4）利用艾滋病诊断提供的教育机会改变危险性行为。研究方法：将80名新诊断的HIV男性（在前三个月内）随机分配到：（1）以创伤为重点的风险降低干预实验条件，或（2）常规护理比较条件。干预完成后，将对研究提供者和参与者进行访谈，并对后勤进行评估，以确定干预的可行性和可接受性。将对以下假设进行检验，以建立疗效的初步评价：（1）在9个月的研究期间，在风险降低干预条件下，与通常的护理比较条件相比，创伤压力和性HIV传播风险行为将减少，以及（2）在降低风险的过程中，新诊断的男性的抑郁症状将减少，医疗和社会服务的利用将增加。干预条件相对于常规护理比较条件。重要性：在艾滋病毒阳性诊断后的“可教时刻”提供积极预防，并与医疗保健无缝结合，将利用单一的机会窗口减少情绪困扰和风险行为，在护理环境中加强预防，并为新诊断的男性建立更安全的性行为轨迹。如果成功，这项研究将提供一种艾滋病毒积极预防干预模式，可以转化为新诊断的男男性行为者的可持续护理模式，这将满足对识别，治疗和预防艾滋病毒感染的护理计划的迫切需求。 公共卫生相关性：据估计，每年有31,000例新的艾滋病毒诊断发生在男男性行为者（MSM）中，占美国所有新艾滋病毒感染的一半以上（56%），和男男性行为者是唯一一个新的艾滋病毒感染率上升的群体。艾滋病毒诊断后的第一年是预防的关键时期，因为超过50%的新诊断男男性行为者在诊断后3至12个月内报告了艾滋病毒传播风险行为。拟议的研究将制定和试点测试一个综合的、基于护理的减少风险干预措施，以解决接受艾滋病毒诊断的急性压力，最大限度地提高新诊断的男子关注减少风险和健康促进信息的能力，并适应新的诊断。