Reducing HIV risk behavior in depressed and non-depressed older adults with HIV

减少患有艾滋病毒的抑郁和非抑郁老年人的艾滋病毒风险行为

• 批准号: 9064649
• 负责人: Travis Ian Lovejoy
• 金额: $ 58.98万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-15 至 2020-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9064649
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adult; Advertisements; Age; Age-Years; Alcohol or Other Drugs use; Anus; Attention; Attitude; Behavior Therapy; Behavioral; Belief; Characteristics; Client; Communities; Comorbidity; Data; Depressed mood; Effectiveness; Elderly; Enrollment; Ensure; Ethnic Origin; Future; Gender; Geography; HIV; HIV Seropositivity; HIV risk; Individual; Intervention; Journals; Knowledge; Life; Mediation; Mediator of activation protein; Mental Depression; Mental Health; Neurocognition; Neurocognitive; Neurocognitive Deficit; Newly Diagnosed; Outcome; Participant; Persons; Population; Preparation; Preventive Intervention; Prophylactic treatment; Protocols documentation; Provider; Public Health; Questionnaires; Race; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Regimen; Reporting; Risk; Risk Behaviors; Rural; Sampling; Secondary Prevention; Self-Administered; Services; Severities; Sex Behavior; Sexual Health; Sexual Partners; Social Work; Telephone; Telephone Interviews; Testing; Therapeutic; Training; Travel; Treatment Efficacy; United States; Vagina; Viral Load result; Work; age related; antiretroviral therapy; base; clinical care; condoms; coping; depressive symptoms; effectiveness clinical trial; efficacy testing; evidence base; flexibility; follow-up; improved; innovation; meetings; motivational enhancement therapy; person centered; physical conditioning; practice-based research network; prevention service; primary outcome; psychiatric symptom; psychosocial; public health relevance; racial diversity; scale up; secondary outcome; seropositive; sex; sexual relationship; sexually active; skills; skills training; social stigma; theories; transmission process; treatment as usual; web site

 DESCRIPTION (provided by applicant): By 2020, 70% of people living with HIV in the United States will be ≥50 years of age due, in large part, to improved clinical care, more efficacious antiretroviral therapy regimens, and the increasing number of persons newly diagnosed with HIV ≥50 years of age. An estimated 37% of sexually active older people living with HIV (OPLWH) continue to engage in HIV transmission sexual behaviors. In spite of repeated calls for secondary prevention interventions to reduce condomless sex in OPLWH, no age-appropriate, evidence-based secondary prevention interventions exist for this group. Many OPLWH cannot engage in face-to-face secondary prevention services because of HIV- and age-related stigma, comorbid mental and physical health conditions that complicate travel to venues in which HIV prevention interventions are delivered, or geographic isolation. High rates of depression and neurocognitive impairment in OPLWH may further complicate engagement in, and reduce benefits of, interventions that aim to reduce HIV transmissions in this group. The proposed study is a randomized controlled trial of a 5-session telephone-administered motivational interviewing plus behavioral skills training (teleMI+BST) intervention to reduce condomless sex in HIV-positive adults 50-plus years of age. A geographically and ethnically/racially diverse sample of 336 OPLWH will be recruited across the U.S. through community-based organizations that serve people living with HIV, rural networks of HIV social service providers, advertisements placed in HIV-related magazines and websites, and online dating forums. Eligible persons will be randomly assigned to receive either a 5-session teleMI+BST intervention or an attention equivalent 5-session telephone-administered coping effectiveness training (teleCET) control intervention. Study therapists will be community-based HIV social service providers located in Portland, OR. Self- administered questionnaires will assess demographic characteristics, and condom use knowledge, beliefs, attitudes, and skills, while a brief telephone interview will assess sexual behavior, substance use, and psychiatric symptoms. A telephone-administered neurocognitive assessment will also be conducted at baseline. Study Aim 1 will test the efficacy of teleMI+BST to reduce occasions of non-condom protected anal and vaginal intercourse with HIV-negative or unknown HIV serostatus partners and examine psychosocial mediators of intervention efficacy. Study Aim 2 will test the efficacy of teleMI+BST to reduce depressive symptoms in mildly depressed participants. Study Aim 3 will test the moderating effect of baseline depressive symptom severity on teleMI+BST efficacy. Additional exploratory analyses will examine the impact of neurocognitive functioning, VL, and pre-exposure prophylaxis (PrEP) use by participants' sexual partners on teleMI+BST efficacy. This study may yield an evidence-based, person-centered intervention that meets the unique sexual relationship and health needs of OPLWH and reduces the transmission of HIV to their HIV- negative sexual partners.

 描述（由申请人提供）：到 2020 年，美国 70% 的艾滋病毒感染者年龄将≥50 岁，这在很大程度上是由于临床护理的改善、更有效的抗逆转录病毒治疗方案以及新诊断的年龄≥50 岁艾滋病毒感染者人数的增加。据估计，性活跃的老年人艾滋病毒感染者 (OPLWH) 中有 37% 继续从事传播艾滋病毒的性行为。尽管一再呼吁采取二级预防干预措施来减少 OPLWH 中的无安全套性行为，但针对该群体不存在适合年龄的、基于证据的二级预防干预措施。许多 OPLWH 无法参与面对面的二级预防服务，因为与艾滋病毒和年龄相关的耻辱、合并的精神和身体健康状况使前往艾滋病毒预防干预措施实施地点的旅行变得复杂，或者地理隔离。 OPLWH 中抑郁症和神经认知障碍的高发生率可能会使旨在减少该群体艾滋病毒传播的干预措施的参与进一步复杂化，并减少其益处。拟议的研究是一项随机对照试验，采用 5 次电话进行动机访谈加行为技能培训 (teleMI+BST) 干预措施，以减少 50 岁以上 HIV 阳性成年人的无套性行为。将通过为艾滋病毒感染者提供服务的社区组织、艾滋病毒社会服务提供者的农村网络、艾滋病毒相关杂志和网站上的广告以及在线约会论坛，在美国各地招募 336 名来自不同地域和民族/种族的 OPLWH。符合条件的人员将被随机分配接受 5 次远程 MI+BST 干预或相当于注意力的 5 次电话管理应对有效性培训 (teleCET) 控制干预。研究治疗师将是位于俄勒冈州波特兰市的社区艾滋病毒社会服务提供者。自填问卷将评估人口特征以及安全套使用知识、信仰、态度和技能，而简短的电话访谈将评估性行为、药物使用和精神症状。还将在基线时进行电话管理的神经认知评估。研究目标 1 将测试 teleMI+BST 的功效，以减少与 HIV 阴性或未知 HIV 血清状态的伴侣进行无安全套保护的肛门和阴道性交的机会，并检查干预效果的社会心理调节因素。研究目标 2 将测试 teleMI+BST 减轻轻度抑郁参与者抑郁症状的功效。研究目标 3 将测试基线抑郁症状严重程度对 teleMI+BST 疗效的调节作用。其他探索性分析将检查神经认知功能、VL 和参与者性伴侣使用的暴露前预防 (PrEP) 对 teleMI+BST 疗效的影响。这项研究可能会产生一种基于证据、以人为本的干预措施，满足 OPLWH 独特的性关系和健康需求，并减少艾滋病毒传播给其艾滋病毒阴性性伴侣。