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）妇女不成比例地受到艾滋病毒/艾滋病的影响。AA妇女感染艾滋病毒的主要风险因素是高风险的异性性行为，包括无保护的阴道和肛交，以及与高风险伴侣发生性行为。危险的酒精使用与高风险性行为和在城市性病诊所就诊的妇女中流行淋病有关，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），在参加城市STI诊所的HIV感染和高危AA妇女中，使用交互式语音应答技术（IVR）通过手机增强呼叫进行文化定制的计算机指导的简短酒精干预（CBI）。将出现STI投诉的危险饮酒AA女性（N=600）随机分配至三组之一：1）常规临床护理，2）基于诊所的CBI，或3）基于诊所的CBI + 3次使用IVR的加强呼叫。CBI是一种基于证据的行为改变方法，将使用动机访谈的原则，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。在3个月、6个月和12个月的时间间隔内测量的主要结果包括与酒精相关的风险行为（暴饮次数、每周饮酒天数和每次饮酒次数）、性风险行为（伴侣数量、无保护阴道/肛交次数、高潮时的性行为次数）和HIV/STI生物标志物的发生率。在实施RCT之前，将对CBI和IVR软件消息进行修订，以：1）包括危险酒精使用与危险性行为之间的关联，2）使用来自参加巴尔的摩市STI诊所的AA女性样本的定量/定性反馈，确保其相关性和可接受性。拟议的研究重点是一个特别脆弱的人口城市艾滋病毒的风险和艾滋病毒感染的AA妇女寻求治疗的公共性病诊所，并检查两个新的BI干预提供战略，专门针对文化/社会相关的这一少数群体。如果干预措施被证明是有效的，研究结果将为“真实的生活”专科护理诊所提供实用、低成本和易于实施的筛查和干预方案。 公共卫生相关性：酗酒与女性性传播感染（STI）有关。在性病专科诊所提供的简短酒精干预措施可以接触到许多有艾滋病毒风险或感染艾滋病毒的非洲裔美国妇女。这项临床试验将评估计算机提供的简短酒精干预和助推器电话的有效性，如果有效，可以在临床环境中广泛实施，以减少酒精使用和其他使妇女面临艾滋病毒风险的行为。

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.