Novel Dissemination of a Group Intervention for HIV+ Women Via Web Conferencing

说明(由申请人提供)：该提案符合国家艾滋病毒/艾滋病研究所的优先研究重点，旨在开发和测试将有效干预措施转化为社区环境的“不同模式”--特别是服务于艾滋病毒阳性者的干预措施(PA-08-166)。在美国，女性感染艾滋病毒的人数正在增加。艾滋病毒携带者妇女面临着巨大的挑战，包括：a)决定是否披露她们的艾滋病毒状况；b)谈判并实践更安全的性行为。虽然健康关系(HR)干预是为了应对这些挑战而开发的，但仍有两个实质性的需求。首先，人力资源需要更好地满足上述妇女妇女的性别具体需求。第二，有必要更广泛地传播到世界卫生组织。虽然人力资源在美国是通过疾控中心的传播有效行为干预(DEBI)项目传播的，但传播仅限于地理区域，在这些区域，临界数量的艾滋病毒携带者可以聚集在一个地点参与，社区机构有时间和资源进行这些努力。因此，拟议的R34研究旨在为妇女健康协会试行和测试视频小组传播改编的、针对性别的健康关系(HR)版本的可行性。我们的团队目前得到资助，与社区咨询委员会(CAB)合作，使人力资源适应健康的关系-网络(HR-W)，以：a)满足妇女特定性别的需求；b)通过在社区地点访问的基于网络的小组视频会议，实现更广泛的交付。这项拟议的研究是下一步确定向世界卫生组织传播HR-W是否可行和有效的关键下一步。在我们目前工作的基础上，拟议研究的具体目标如下：1)进行HR-W与WLH的试点测试，并进行必要的修改以最终完成手册；以及2)进行小型部分交叉可行性试验，比较HR-W与等待名单对照(WLC)，为大型随机对照试验(RCT)做准备。对于目标1，我们将进行单组试点测试，并收集参与者的反馈，以在我们现有CAB的帮助下改进HR-W手册。对于目标2，WLH将随机分为HR-W(n=35)和WLC(n=35)条件。HR-W参与者将在基线评估后立即接受干预。在两种情况下完成6个月的随访评估后，WLC参与者将转到HR-W条件下，接受干预，并在6个月后完成随访。在为大型随机对照试验(和R01应用)做准备的过程中，该项目的总体目标是确定通过视频会议提供HR-W是可行的，并收集证据表明HR-W可能导致性危险行为的显著减少。长期目标是在城市以及地理分散、低流行率和资源贫乏的环境中建立卫生和生殖健康服务的有效性。 公共卫生相关性：通过在社区干预站接入的团体视频会议成功地传播健康的关系-网络将对方法和公共卫生产生深远的影响。首先，这项研究将确定在线传播经过调整的健康关系版本的可行性，以便尽管存在社会经济和地理障碍，更多的艾滋病毒携带者妇女可以受益于干预措施的社会支持和技能培养部分。其次，这项研究将极大地促进人们对在线传播以群体为基础的干预措施的当前理解，从而推动行为翻译科学的发展，从而建立可用于调整和传播一系列针对一系列公共卫生问题的一级、二级和三级预防干预措施的知识。

DESCRIPTION (provided by applicant): This proposal fits with the NIMH priority for research aimed at developing and testing "different modes for transferring efficacious interventions" into community settings--especially with regard to interventions serving HIV-positive persons (PA-08-166). In the U.S., HIV among women is increasing. Women living with HIV (WLH) face tremendous challenges, including: a) making decisions about disclosing their HIV status; and b) negotiating for and practicing safer sexual behavior. Although the Healthy Relationship (HR) intervention was developed to address these challenges, two substantial needs remain. First, there is a need for HR to better address the above described gender specific needs of WLH. Second, there is a need for more widespread dissemination to WLH. Although HR is disseminated in the US by CDC's Dissemination of Effective Behavioral Interventions (DEBI) project, dissemination is limited to geographical areas in which a critical mass of people with HIV can meet in a single location to participate, and where community agencies have the time and resources for these efforts. As such, the proposed R34 study is designed to pilot and feasibility test video group dissemination of an adapted, gender-specific version of Healthy Relationships (HR) for WLH. Our team is currently funded to work with a Community Advisory Board (CAB) to adapt HR into Healthy Relationships-Web (HR-W) to: a) address women's gender-specific needs; and b) enable more widespread delivery through web-based group videoconferencing accessed at community locations. This proposed study is the critical next step towards determining whether or not it is feasible and effective to disseminate HR-W to WLH. Building upon our current work, specific aims of the proposed study are as follows: 1) Conduct pilot testing of HR-W with WLH and make any necessary adaptations to finalize the manual; and 2) Conduct a small partial cross-over feasibility trial comparing HR-W with a wait-list control (WLC), in preparation for a large randomized controlled trial (RCT). For Aim 1, we will conduct a single-group pilot test and garner feedback from participants to improve the HR-W manual with assistance from our existing CAB. For Aim 2, WLH will be randomized into the HR-W (n=35) and WLC (n=35) conditions. HR-W participants will receive the intervention immediately after a baseline assessment. After both conditions complete a 6-month follow-up assessment, WLC participants will cross over to the HR-W condition, receive the intervention, and complete a follow-up 6 months later. In preparation for a large RCT (and R01 application), the overall goals of this project are to establish that it is feasible to provide HR-W through videoconferencing and gather evidence suggesting that HR-W may lead to significant reductions in sexual risk behavior. The long-term goal is to establish effectiveness of HR-W for WLH in urban as well as geographically dispersed, low-prevalence, and resource- poor environments. PUBLIC HEALTH RELEVANCE: The successful dissemination of Healthy Relationships-Web through group videoconferencing accessed at community-located intervention stations will have far-reaching methodological and public health impacts. First, this study will establish the feasibility of online dissemination of an adapted version of Healthy Relationships so that, despite socioeconomic and geographic barriers, many more women living with HIV can benefit from the intervention's social support and skills building components. Second, this study will advance behavioral translation science by contributing significantly to current understandings of disseminating group-based interventions online, thus establishing knowledge that can then be used to adapt and disseminate an array of primary, secondary, and tertiary prevention interventions for a range of public health issues.