PILOT INTERVENTION TO EMPOWER HIV CLIENTS AS PREVENTION ADVOCATES IN UGANDA

项目摘要 艾滋病毒/艾滋病感染者（PLHA）在艾滋病毒预防方面发挥着关键作用，不仅是在 预防阳性和治疗作为预防，但作为艾滋病毒保护的强大变革因素 行为等。我们的研究表明，随着PLHA接受艾滋病毒治疗并恢复健康， 和功能，许多人的动机是保护他们的亲人和从事预防宣传（即，到 鼓励朋友和家人寻求艾滋病毒检测和治疗，并减少危险行为）;然而， 信息内容、风格和提供时间方面的挑战阻碍了宣传的质量， 选择宣传对象。通过有效的宣传培训，动员艾滋病毒携带者/艾滋病患者成为变革推动者 在他们的社交网络中，艾滋病毒的传播有可能成为艾滋病毒预防的“游戏规则改变者”，特别是在高收入国家， 在乌干达等艾滋病流行地区，几乎每个家庭都接触到艾滋病毒感染者。 利用基于网络的干预措施的理论框架，如社会传播理论， 认知一致性和社会影响，拟议的研究将开发和试点测试“游戏改变者”-- 一种干预措施，旨在增强和动员PLHA成为艾滋病毒预防和行为的代理人 改变他们的社交网络。在第一阶段，我们将分别为艾滋病毒携带者/艾滋病患者和 他们的社交网络（家人和朋友），以探讨动员客户进行宣传的障碍和促进因素 对于艾滋病毒预防，关于宣传如何最有效地激励行为改变的看法，以及 如何最好地组织干预及其内容。在第二阶段，我们将使用第一阶段的发现， 从基于网络的干预模式发展干预的结构和内容， 帮助客户科普耻辱，管理他们的疾病，积极生活，并培养艾滋病毒的动力和技能 披露和预防宣传。在第三阶段，我们将在96名受试者的对照试验中试行团体干预。 48名随机分配接受干预，48名等待名单控制。评估将 在基线和第4、8和12个月时对所有参与者施用，之后对照组将 接受干预。调查和社会网络评估将检查干预对以下方面的影响： 参与者的保护行为（使用避孕套，坚持艾滋病毒治疗）和预防的传播 通过与网络通信的内容和范围进行评估， 成员关于保护性行为（安全套的使用，伴侣并发/伴侣数量，艾滋病毒检测， 参与艾滋病毒护理，包皮环切术），艾滋病毒披露和艾滋病毒污名。Game Changers是创新的， 包括所有主要艾滋病毒预防模式的各个方面，针对所有网络成员进行宣传， 而不是在特定的风险群体中，并使用社会网络数据不仅评估影响， 战略目标宣传。研究结果将为更大规模的R 01试验提供信息。

Project Summary People living with HIV/AIDS (PLHA) have a critical role to play in HIV prevention, not only in the context of Prevention for Positives and Treatment as Prevention, but as powerful change agents for HIV protective behaviors among others. Our research suggests that as PLHA receive HIV treatment and restore their health and functioning, many are motivated to protect their loved ones and engage in prevention advocacy (i.e., to encourage friends and family to seek HIV testing and treatment, and to reduce risk behavior); however, the quality of this advocacy is hampered by challenges related to message content, style and timing of delivery, and selection of advocacy recipients. With effective advocacy training, mobilizing PLHA to be change agents within their social networks has the potential to be a “game changer” for HIV prevention, particularly in high prevalence settings such as Uganda, where virtually every family is touched by someone living with HIV. Drawing upon theoretical frameworks for network-based interventions, such as theories of social diffusion, cognitive consistency, and social influence, the proposed study will develop and pilot test “Game Changers”-- an intervention that aims to empower and mobilize PLHA to be agents for HIV prevention and behavioral change in their social networks. In Phase 1, we will conduct separate focus groups of PLHA and members of their social networks (family and friends) to explore barriers to and facilitators of mobilizing clients to advocate for HIV prevention, perceptions on how advocacy can be most effective in motivating behavior change, and how to best structure the intervention and its content. In Phase 2 we will use findings from Phase 1, and draw from network-based intervention models to develop the structure and content of an intervention designed to help clients cope with stigma, manage their disease, live positively, and develop motivation and skills for HIV disclosure and prevention advocacy. In Phase 3 we will pilot the group intervention in a controlled trial of 96 clients, with 48 randomly assigned to receive the intervention and 48 to the wait-list control. Assessments will be administered to all participants at baseline and months 4, 8 and 12, after which the control group will receive the intervention. Surveys and social network assessments will examine intervention effects on protective behaviors of the participant (condom use, HIV treatment adherence), and diffusion of prevention messages across the network, as assessed by the content and extent of communication with network members about protective behaviors (condom use, partner concurrency/number of partners, HIV testing, engagement in HIV care, circumcision), HIV disclosure, and HIV stigma. Game Changers is innovative as it encompasses aspects of all major HIV prevention paradigms, targets advocacy to all network members rather than within and by specific risk groups, and uses social network data not only to evaluate effects but also strategically target advocacy. Findings will inform a larger R01 trial.