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

描述（由申请人提供）：该提案符合NIMH的优先研究目标，旨在开发和测试“将有效干预措施转移到社区环境的不同模式”——特别是关于为艾滋病毒阳性患者提供干预措施（PA-08-166）。在美国，女性感染艾滋病毒的人数正在增加。感染艾滋病毒的妇女面临着巨大的挑战，包括：a)决定是否披露自己的艾滋病毒状况；b)协商并实施更安全的性行为。虽然制定健康关系干预措施是为了应对这些挑战，但仍然存在两个实质性需求。首先，人力资源部门需要更好地解决上述职场女性的性别特定需求。第二，需要更广泛地向WLH传播。虽然人力资源通过疾病预防控制中心的有效行为干预传播（DEBI）项目在美国传播，但传播仅限于地理区域，在这些区域，艾滋病毒感染者的临界质量可以在一个地方聚会并参与，社区机构有时间和资源进行这些努力。因此，拟议的R34研究旨在试点和可行性测试视频小组传播的改编，性别特定版本的健康关系（HR）为WLH。我们的团队目前得到资助，与社区咨询委员会（CAB）合作，将人力资源纳入健康关系网（HR- w），以便：a)解决妇女的特定性别需求；b)通过在社区地点访问的基于网络的群组视频会议实现更广泛的交付。这项拟议的研究是确定HR-W向WLH传播是否可行和有效的关键下一步。基于我们目前的工作，建议研究的具体目标如下：1)进行HR-W与WLH的试点测试，并进行任何必要的调整，以最终确定手册；2)进行HR-W与等候名单对照（WLC）的小规模局部交叉可行性试验，为大规模随机对照试验（RCT）做准备。对于目标1，我们将进行单组试点测试，并在现有CAB的协助下收集参与者的反馈，以改进HR-W手册。在Aim 2中，WLH将被随机分为HR-W （n=35）和WLC （n=35）两组。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参与者将过渡到HR-W状态，接受干预，并在6个月后完成随访。为了准备一项大型随机对照试验（R01应用），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可能会显著降低性风险行为。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确定HR-W对WLH的有效性。

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.