Alcohol Use and High Risk Behavior Among HIV-Positive Men

HIV 阳性男性的饮酒和高风险行为

• 批准号: 8541465
• 负责人: SARAH E WOOLF-KING
• 金额: $ 18.08万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-06 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8541465
• 关键词: AIDS prevention; Accounting; Adherence; Adult; Affect; Africa; Africa South of the Sahara; African; African American; Alcohol consumption; Alcoholic Intoxication; Alcohols; Anti-Retroviral Agents; Applied Research; Attention; Behavior; Behavioral; Biological; Cellular Phone; Clinical; Coitus; Consumption; Coupled; Cross-Sectional Studies; Data; Data Collection; Development; Epidemic; Event; Feedback; Fire - disasters; Foundations; Frequencies; Funding; Goals; HIV; HIV Seropositivity; HIV risk; Hour; Individual; International; Intervention; Interview; K-Series Research Career Programs; Laboratories; Lead; Life; Link; Literature; Mentorship; Monitor; National Institute on Alcohol Abuse and Alcoholism; Participant; Patient Self-Report; Pattern; Personality; Persons; Population; Prevalence; Preventive Intervention; Principal Investigator; Prostate-Specific Antigen; Prostitution; Psychologist; Public Health; Randomized Controlled Trials; Reporting; Research; Research Activity; Research Design; Review Literature; Risk; Risk Behaviors; Risk Reduction; Scientist; Self-Administered; Seminal fluid; Swab; Techniques; Technology; Testing; Time; Training; Translating; Treatment Efficacy; Uganda; United States National Institutes of Health; Unsafe Sex; Vagina; Voice; Woman; Work; World Health Organization; base; career; career development; cohort; design; efficacy testing; high risk; high risk behavior; high risk men; longitudinal analysis; men; monitoring device; multilevel analysis; patient oriented; programs; prospective; public health relevance; research and development; response; self reported behavior; sex risk; sexually active; skills; skills training; theories; therapy development; transmission process; university student

DESCRIPTION (provided by applicant): Alcohol consumption in sub-Saharan Africa is a major public health concern that has received insufficient attention. The World Health Organization (WHO) estimates that although 70% of adults in sub- Saharan Africa are self-reported abstainers, the 30% who report consuming alcohol have among the highest levels of per capita consumption in the world. The heavy, episodic pattern of consumption that characterizes alcohol use in this region is associated with many negative HIV-related consequences including an increased likelihood of engaging in high risk behavior and a higher cumulative risk of onward transmission among sero-discordant partnerships. The intersection of these two epidemics underscores the urgency of increased research attention and intervention development. Research aimed at understanding how, and in what contexts, alcohol is most likely to result in high risk behavior in sub-Saharan Africa has been dominated by cross-sectional study designs that fail to capture the temporal relationship between alcohol consumption and its subsequent effect on risky behavior. The overall objective of this K01 Career Development Award is to achieve a better understanding of the relationship between event-level alcohol use and high risk behavior among HIV-positive (HIV+) African adults using cell- phone based, daily data collection techniques. The long-term goal of this application is to develop a behavioral HIV prevention intervention targeting alcohol use that can be implemented with HIV+ adults in sub-Saharan Africa and to provide the principal investigator, Dr. Woolf-King, with the skills and training necessary to successfully develop and test the efficacy of this intervention. Dr. Woolf-King is trained as a clinical psychologist with expertise in the use of laboratory-based, alcohol administration studies for determining the causal effect of event-level alcohol intoxication on the behavior of high risk men, college students, and African American adults. Dr. Woolf-King's long-term goal is to become a successful NIH-funded behavioral scientist with international expertise in alcohol's relationship to HIV. She has proposed a combination of didactic and applied research activities, under the mentorship of experts in the field, to provide her with the following skills necessary to accomplish this goal: (1) the design and analysis of longitudinal event-level research, (2) the use of biological data to estimate the accuracy of self-reported behavior, and (3) the development of behavioral HIV prevention intervention development. The proposed research consists of three specific aims and will be conducted in conjunction with Dr. Judy Hahn's ongoing NIH/NIAAA-funded (R01 and U01) cohorts of ART-na¿ve, HIV+ African adults. Aim 1: Enhance our understanding of the event-level association between alcohol consumption and high risk behavior among HIV+ adults in Africa. We will accomplish this aim by: (a) conducting a prospective, event-level study with 100 HIV+ men (n= 50) and women (n =50) who report consuming alcohol in the last three months, (b) assessing the situational and relationship-level aspects of high risk events over a six- week period using interactive voice response (IVR) technology, and (c) using a theory-guided conceptual framework and advanced multilevel modeling to determine the extent to which individual, situational, and relationship-leve variables work together to explain the association between alcohol use and risky behavior. Aim 2: Estimate the accuracy of self-reported high risk behavior using biological data.. We will accomplish this aim by: (a) using a qualitative test for Prostate Specific Antigen (PSA), an indicator of recent (i.e., last 24 hours) semen exposure that can be reliably recovered from self-administered vaginal swabs, (b) comparing these PSA tests to self-report of risky behavior in the last 24 hours, and (c) using women with positive PSA tests to estimate self-report bias. Aim 3: Develop a plan for an intervention targeting alcohol use and high risk behavior that incorporates event-level data collected with IVR. We will accomplish this aim by: (a) conducting brief qualitative exit interviews with a sub-group of participants in the event-level study to assess the feasibility and acceptability of IVR as a self-monitoring device, (b) using an existing alcohol use risk reduction intervention to guide us in translating these self-monitoring data into personalized feedback that highlights the within-person variability in alcohol's relationship to risky behavior and (c) ultimately developing a new brief, patient-centered HIV risk-reduction intervention for high risk, alcohol consuming HIV+ adults in Africa. These research activities will culminate in the submission of an R34 as part of NIAAA's Behavioral and Integrative Treatment Development Program, during the 4th year of the K-award period, to further develop and pilot test the intervention that emerges from these specific aims. This will lead directly to the submission of an R01 to conduct a full Randomized Controlled Trial (RCT) of the intervention to determine its efficacy. The career development and research activities proposed in this K01 application will lay the foundation for Dr. Woolf-King's career as successful, independent, NIH-funded behavioral scientist with the skills to conduct a wide-range of research on alcohol's relationship to the HIV epidemic, both domestically and internationally.

描述（由申请人提供）：撒哈拉以南非洲的酒精消费是一个主要的公共卫生问题，没有得到足够的重视。世界卫生组织（WHO）估计，尽管撒哈拉以南非洲70%的成年人自我报告为戒酒者，但报告饮酒的30%的人是世界上人均消费水平最高的人。该地区酒精使用的特点是大量的、间歇性的消费模式，这与许多与艾滋病毒相关的负面后果有关，包括从事高风险行为的可能性增加，以及血清不一致伙伴关系中向前传播的累积风险更高。这两种流行病的交叉凸显了增加研究关注和干预措施开发的紧迫性。 旨在了解如何以及在什么情况下，酒精最有可能导致撒哈拉以南非洲地区的高风险行为的研究一直由横断面研究设计主导，未能捕捉酒精消费及其对风险行为的后续影响之间的时间关系。K 01职业发展奖的总体目标是利用基于手机的日常数据收集技术，更好地了解艾滋病毒阳性（HIV+）非洲成年人事件级饮酒与高危行为之间的关系。该应用程序的长期目标是开发一种针对酒精使用的行为艾滋病毒预防干预措施，可以在撒哈拉以南非洲的艾滋病毒阳性成年人中实施，并为首席研究员Woolf-King博士提供成功开发和测试这种干预措施的有效性所需的技能和培训。 博士伍尔夫-金是一名临床心理学家，擅长使用基于实验室的， 酒精管理研究，以确定事件水平的酒精中毒对高危男性，大学生和非洲裔美国成年人的行为的因果关系。Woolf-King博士的长期目标是成为一名成功的NIH资助的行为科学家，在酒精与HIV的关系方面拥有国际专业知识。她提出了教学和应用研究活动相结合，在该领域的专家的指导下，为她提供实现这一目标所需的以下技能：（1）纵向事件水平研究的设计和分析，（2）使用生物学数据来估计自我报告行为的准确性，以及（3）行为艾滋病预防干预发展的发展。拟议的研究包括三个具体目标，并将与Judy Hahn博士正在进行的NIH/NIAAA资助的（R 01和U 01）ART初治、HIV+非洲成年人队列研究一起进行。 目标1：加强我们对非洲艾滋病毒阳性成年人饮酒与高危行为之间事件水平关联的理解。我们将通过以下方式实现这一目标：（a）对100名HIV阳性男性（n= 50）和女性（n =50）进行前瞻性事件水平研究，这些人报告在过去三个月内饮酒，（B）使用交互式语音应答（IVR）技术评估六周期间高风险事件的情境和关系水平方面，以及（c）使用理论指导的概念框架和先进的多层次模型来确定个体、情境和关系水平变量在多大程度上共同作用来解释酒精使用和危险行为之间的关联。 目的2：使用生物学数据估计自我报告的高风险行为的准确性。我们将通过以下方式实现这一目标：（a）使用前列腺特异性抗原（PSA）的定性检测，PSA是近期（即，最后24小时）精液暴露，可以可靠地从自我管理的阴道拭子中恢复，（B）比较这些PSA测试与自我报告的危险行为在最后24小时，和（c）使用PSA测试阳性的妇女来估计自我报告的偏差。 目标3：制定一项针对酒精使用和高风险行为的干预计划，其中包括使用IVR收集的事件级数据。我们将通过以下方式实现这一目标：（a）在事件层面研究中，与一小部分参与者进行简短的离职前质性面谈，以评估以互动电话录音系统作为自我监察工具的可行性和可接受性，（B）使用现有的酒精使用风险降低干预措施，指导我们将这些自我监测数据转化为个性化反馈，突出内部-酒精与危险行为关系的个体差异，以及（c）最终为非洲高风险、饮酒的HIV+成人开发一种新的简短的、以患者为中心的降低HIV风险的干预措施。 这些研究活动将最终在提交R34作为NIAAA的行为和综合治疗发展计划的一部分，在K奖期间的第四年，以进一步开发和试点测试从这些特定目标中出现的干预措施。这将直接导致提交R 01，以进行干预措施的完整随机对照试验（RCT），以确定其疗效。在此K 01应用程序中提出的职业发展和研究活动将为伍尔夫-金博士的职业生涯奠定基础，作为成功的，独立的，NIH资助的行为科学家，具有进行酒精与艾滋病毒流行病的关系的广泛研究的技能，无论是国内还是国际。