A Tailored Cue-Card Driven HIV/STI Intervention for High Risk Groups Pilot Study

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DESCRIPTION (provided by applicant): HIV and other sexually transmitted infections (STIs) are serious problems in many parts of the United States, including rural areas. While HIV risk groups in rural areas are similar to those in urban areas, the lower population density results in smaller numbers of most groups, such as injecting drug users (IDUs) and noninjecting drug users, sex workers, and men who have sex with men (MSM). Most health education materials and behavioral interventions are targeted to a specific audience or risk group and research has shown that interventions tailored to be gender specific and culturally sensitive are more effective than generic interventions. However, the small numbers of some of these groups in rural areas make it difficult for providers to justify the cost of maintaining staff and other resources that are needed to deliver interventions tailored to each demographic and risk group. The proposed study will draw from proven interventions to refine and pilot test a cue-card driven computer-assisted intervention that will be tailored to each participant's demographic characteristics, risk behaviors and biological test results. This intervention builds on our earlier intervention and epidemiological work with IDUs, crack users, sex workers, and MSM in rural and urban settings in which we found similar levels of HIV and other STIs in rural and urban areas. We also found that MSM, sex workers, IDUs and non-injecting drug users were all present, although in smaller numbers, in the rural areas. Therefore, we propose to pilot test the intervention in a medium-sized metropolitan area, where we have an urban field site to ensure that we have adequate numbers of participants in each risk group. Subsequently, we will assess the acceptability and feasibility of conducting the intervention in a rural setting, where we have also established a field site and presence. The proposed study will be conducted in three stages. The intervention will be refined during Stage 1, pilot tested in Stage 2, and the feasibility and acceptability of using the intervention in a rural area will be assessed in Stage 3. The specific aims of the proposed study are: 1. To refine a cue-card driven computer-assisted intervention that will be tailored to each participant's demographic characteristics (e.g. gender, ethnicity), risk behaviors and biological test results. 2. To pilot test the tailored intervention's effects on sexual risk behaviors (i.e., number of partners, frequency of unprotected sex) and drug use (e.g., frequency of use, frequency of use while having sex) and disease-specific knowledge (e.g., hepatitis B and C, genital herpes) using a two group randomized design with a generic intervention as a comparison group. 3. To assess the feasibility and acceptability of the tailored intervention in a rural setting. PUBLIC HEALTH RELEVANCE: The intervention that will be refined and pilot tested in this project may be very useful for reducing HIV and other sexually transmitted infections (STIs) and transmission and risk behaviors among high risk groups, particularly in rural areas. The intervention may also substantially reduce the burden on counselors that are responsible for providing multiple test results in settings where HIV, STI, and hepatitis testing and services are integrated.