Computerized BI for Binge Drinking HIV At-Risk & Infected African-American Women

描述（由申请人提供）：非裔美国人（AA）妇女受艾滋病毒/艾滋病的影响不成比例。嗜酒者协会妇女感染艾滋病毒的主要危险因素是高风险异性性行为，包括无保护的阴道和肛交，以及与高风险伴侣的性行为。在城市性传播感染诊所就诊的妇女中，危险饮酒与高风险性行为和淋病流行有关，这两者都增加了妇女感染和传播艾滋病毒的脆弱性。本申请提出了一项随机对照试验（RCT），在城市性传播感染诊所就诊的艾滋病毒感染者和有风险的AA妇女中进行文化定制的计算机指导的短暂酒精干预（CBI），并使用交互式语音应答技术（IVR）增强手机助推器呼叫。以性传播感染为主诉的危险饮酒AA女性（N=600）将被随机分为三组：1)常规临床护理，2)基于临床的CBI，或3)基于临床的CBI +使用IVR的3次助推器呼叫。CBI是一种以证据为基础的行为改变方法，它将使用动机性访谈原则，就以下问题提供咨询：1)饮酒和2)相关的艾滋病毒/性传播感染风险行为。以3个月、6个月和12个月为间隔测量的主要结局包括酒精相关风险行为（酗酒次数、饮酒天数/周、每次饮酒次数）、性风险行为（性伴侣数量、无保护阴道/肛交次数、高强度性行为次数）和HIV/STI生物标志物的发生。在实施RCT之前，CBI和IVR软件信息将被修改为：1)包括危险酒精使用与危险性行为之间的关联，2)使用来自巴尔的摩市STI诊所AA妇女样本的定量/定性反馈确保其相关性和可接受性。本研究的重点是在公共性传播感染诊所寻求治疗的城市艾滋病毒高危人群和艾滋病毒感染的AA妇女，并研究了两种专门针对这一少数群体的文化/社会相关的新型BI干预交付策略。如果干预被证明是有效的，研究结果将为“现实生活”的专科护理诊所提供一套实用、低成本、易于实施的筛查和干预方案。

DESCRIPTION (provided by applicant): African American (AA) women are disproportionately affected by HIV/AIDs. The major risk factor for HIV acquisition among AA women is high-risk heterosexual sex, including unprotected vaginal and anal sex, and sex with a high-risk partner. Hazardous alcohol use has been associated with high risk sexual behaviors and prevalent gonorrhea among women attending an urban STI clinic, both of which increase a woman's vulnerability to HIV acquisition and transmission. This application proposes a randomized controlled trial (RCT) of a culturally tailored computer-directed brief alcohol intervention (CBI) enhanced with cell-phone booster calls using interactive voice response technology (IVR) among HIV- infected and at-risk AA women attending an urban STI Clinic. Hazardous drinking AA women (N=600) presenting with STI complaints will be randomized to one of three arms: 1) usual clinical care, 2) clinic-based, CBI, or 3) clinic- based, CBI + 3 booster calls using IVR. The CBI, an evidence-based based method for behavior change, will use principles of motivational interviewing, to counsel on: 1) alcohol use and 2) associated HIV/STI risk behaviors. Primary outcomes, measured at 3, 6, and 12 month intervals, include alcohol-related risk behaviors (number of binge drinking episodes, drinking days/week, and drinks per occasion), sexual risk behaviors (number of partners, episodes of unprotected vaginal/anal sex, episodes of sex while high), and occurrence of HIV/STI biomarkers. Prior to implementing the RCT, the CBI and IVR software messages will be revised to: 1) include the association between hazardous alcohol use and risky sexual behaviors, and 2) ensure their relevance and acceptability using quantitative/qualitative feedback from a sample of AA women attending a Baltimore City STI clinic. The proposed research focuses on a particularly vulnerable population of urban HIV at-risk and HIV-infected AA women seeking treatment in a public STI clinic and examines two novel BI intervention delivery strategies specifically tailored to be culturally/socially relevant to this minority population. If the intervention(s) prove to be effective, study findings will offer "real life" specialty care clinics a screening and intervention package that is practical, low cost, and easy to implement. PUBLIC HEALTH RELEVANCE: Binge drinking is associated with sexually transmitted infections (STI) among women. Brief alcohol interventions offered in clinics specializing in STI could reach many African American women either at-risk for or infected with HIV. This clinical trial will assess the effectiveness of computer delivered brief alcohol intervention and booster phone calls, which if effective, could be implemented widely in clinical settings to reduce alcohol use and other behaviors that place women at risk for HIV.