PS09-007, Evaluating Locally Developed Homegrown HIV Prevention Interventions

描述（由申请人提供）：直接或间接与男性间性交有关的HIV感染是非洲裔美国人HIV感染的唯一主要原因，估计占美国所有非洲裔美国男性艾滋病诊断病例的50%。 尽管这种不成比例的负担，艾滋病毒预防/降低风险的干预措施已被专门设计和评估的非洲裔美国男性谁与男性发生性关系（AAMSM）的疗效。 这项拟议的研究将通过实施和严格测试在纽约市300名年龄在18-55岁的AAMSM样本中减少艾滋病毒风险行为的有效性来解决这一差距。CTCA战略是一个土生土长的非洲裔美国人文化知情模型，已在加州的洛杉矶实施了十多年，自2002年以来，在纽约市实施。基于社会认知行为理论，CTCA干预结合了批判性思维，非裔美国人的文化意识，健康素养，咨询和团体动力，使AAMSM能够减少他们的艾滋病毒风险行为，走向自我实现，对自己和社区承担更大的责任。 拟议的研究将比较CTCA干预与标准HIV检测和咨询方案（标准护理），假设：1）完成干预的参与者将报告比标准护理对照组更大的性风险行为减少; 2）CTCA干预比标准护理更具成本效益。与提供干预有效性最佳证据的既定标准一致，本研究将采用试验前/试验后设计，随机分配至干预组和对照组;制定了在研究完成时保留至少70%参与者的策略;在基线、干预后即刻以及至少在干预后3个月和6个月收集数据;严格衡量直接影响AAMSM艾滋病毒风险的结果（例如，性伴侣的数量、避孕套的使用）或指示HIV或STD感染的生物测量。本研究的具体目的是：1）进一步阐明和发展本土CTCA干预，2）评估其在减少AAMSM的HIV风险行为方面的有效性和成本效益，3）从而扩大AAMSM HIV预防/风险降低实践的有限研究。 相关性：鉴于缺乏经过测试和有效的艾滋病毒预防干预措施，AAMSM和他们的不成比例和不断上升的艾滋病毒负担，拟议的研究解决了最紧迫的公共卫生需求。 提高对AAMSM中艾滋病毒/艾滋病的风险行为、发病率和发病率的认识，并为他们制定有效的风险干预措施，必须成为扭转美国非洲裔美国人中艾滋病日益恶化的议程的一部分。

DESCRIPTION (provided by applicant): HIV infection directly or indirectly related to male-to-male sexual intercourse is the single major contributor to HIV infection among African-Americans, accounting for an estimated 50% of all US AIDS cases diagnosed among African-American men. Despite this disproportionate burden, few HIV prevention/risk reduction interventions have been specifically designed and evaluated for efficacy among African American men who have sex with men (AAMSM). The proposed study will address this gap by implementing and rigorously testing the efficacy in reducing HIV risk behaviors among a sample of 300 AAMSM aged 18-55 in New York City of the Critical Thinking and Cultural Affirmation (CTCA) HIV risk behavior intervention. The CTCA strategy is a home-grown, African-American culturally-informed model which has been implemented for over a decade in Los Angeles, California, and since 2002, in New York City. Based in social cognitive behavioral theory, the CTCA intervention combines critical thinking, African- American cultural awareness, health literacy, counseling and group dynamics to empower AAMSM to reduce their HIV risk behaviors and move toward self-actualization and greater responsibility for themselves and their community. The proposed study will compare the CTCA intervention to standard HIV testing and counseling protocol (standard of care), hypothesizing: 1) that participants who complete the intervention will report greater reductions in sexual risk behaviors than the standard care comparison group; and 2) that the CTCA intervention is more cost effective than the standard of care. Consistent with established criteria for providing best-evidence of intervention efficacy, the study will be a pre-test/post- test design with randomized assignment to intervention and comparison groups; have a strategy to retain at least 70% of participants through study completion; collect data at baseline, immediately post- intervention, and at a minimum, at 3 and 6 months post-intervention; rigorously measure outcomes that directly impact AAMSM's HIV risk (e.g., number of sex partners, condom use) or a biologic measure indicating HIV or STD infection. The Specific Aims of this study are 1) to further explicate and develop the homegrown CTCA intervention, 2) to evaluate its efficacy and cost-effectiveness in reducing AAMSM's HIV risk behaviors, and 3) thereby to expand the limited body of research on HIV prevention/risk reduction practices for AAMSM. Relevance: Given the shortage of tested and effective HIV prevention interventions for AAMSM and their disproportionate and rising HIV burden, the proposed study addresses a most urgent public health need. Advancing understanding of the risk behaviors, rates and incidence of HIV/AIDS among AAMSM, and creating effective risk interventions for them must be part of the agenda to reverse the worsening epidemic among African-Americans in the United States.