Behavioral Intervention to Enhance HIV Test/Treat

描述(由申请人提供)：旨在检测和治疗人的艾滋病毒感染的预防战略因艾滋病毒治疗不遵守和性传播联合感染(STI)而受到破坏。迫切需要可推广的干预措施，通过提高艾滋病毒治疗的依从性和降低传播艾滋病毒的风险来维持低传染性。这项申请建议测试一种基于理论的行为干预，以同时提高艾滋病毒治疗的依从性，并减少使用酒精和其他药物的艾滋病毒/艾滋病患者的艾滋病毒传播危险行为。基于决策冲突理论，干预将以混合形式提供，先是一次办公室咨询会议，然后是四次手机咨询会议。干预将在亚特兰大及周边贫困地区进行。接受艾滋病毒治疗的男性(n=250)和女性(n=250)将从艾滋病服务机构和传染病诊所招募。在知情同意和基线评估之后，参与者将被随机分配到(A)综合艾滋病毒治疗坚持-降低风险干预或(B)时间匹配的无污染注意控制条件。参与者将被跟踪12个月，使用基于办公室的计算机化访谈、未宣布的药片计数和医疗图表摘要。这项研究将检验这样一种假设，即统一、综合的、基于理论的艾滋病毒治疗和降低风险干预将减少艾滋病毒传播危险行为，提高艾滋病毒治疗的依从性，减少病毒载量，防止新的性传播感染。这项研究还将检验理论结构和结构性障碍对干预结果的影响。在12个月的随访期内，与病毒载量和性传播感染相关的预测复发的因素和危险行为也将是研究的重点。正在调查的干预措施将是首批同时处理治疗依从性和危险行为的干预措施之一，采用艾滋病毒阳性男子和妇女的物质综合模式。如果证明有效，干预模式将准备好立即传播到社区和艾滋病毒/艾滋病患者的临床服务中。 公共卫生相关性：旨在检测和治疗人们感染艾滋病毒的预防战略受到艾滋病毒治疗不力和性传播联合感染(STI)的破坏。这项拟议的研究将测试一种基于理论的行为干预措施，通过同时提高艾滋病毒治疗依从性和减少使用酒精和其他药物的艾滋病毒/艾滋病患者的性传播联合感染来降低艾滋病毒的传染性。干预是在一个办公室的咨询会议中提供的，然后是4个手机提供的咨询会议，这种模式将准备好立即传播到病例管理和临床服务，在资源有限的情况下为艾滋病毒/艾滋病患者提供服务。

DESCRIPTION (provided by applicant): Prevention strategies that aim to test and treat people for HIV infection are undermined by HIV treatment non-adherence and sexually transmitted co-infections (STI). Scalable interventions are urgently needed to sustain low infectiousness by improving HIV treatment adherence and reducing risks for transmitting HIV. This application proposes to test a theory-based behavioral intervention to simultaneously improve HIV treatment adherence and reduce HIV transmission risk behaviors in people living with HIV/AIDS who use alcohol and other drugs. Grounded in Conflict Theory of Decision Making, the intervention will be delivered in a mixed format, with one office-based counseling session followed by four cell phone delivered counseling sessions. The intervention will be conducted in Atlanta and surrounding impoverished areas. Men (n = 250) and women (n = 250) receiving HIV treatment will be recruited from AIDS services and infectious disease clinics. Following informed consent and baseline assessments, participants will be randomly assigned to either an (a) integrated HIV treatment adherence - risk reduction intervention or (b) a time-matched non-contaminating attention control condition. Participants will be followed for 12-months using office-based computerized interviews, unannounced pill counts, and medical chart abstraction. The study will test the hypothesis that a unified, integrated theory-based HIV treatment and risk reduction intervention will reduce HIV transmission risk behaviors, improve HIV treatment adherence, reduce viral load and prevent new STI. The study will also examine the influence of theoretical constructs and structural barriers on intervention outcomes. Factors that predict relapse to non-adherence and risk behaviors in relation to changes in viral load and STI over the 12-month follow-up period will also be a focal point of the study. The intervention under investigation will be among the first to simultaneously address treatment adherence and risk behavior in an integrated model for substance using HIV positive men and women. If shown effective, the intervention model will be ready for immediate dissemination to community and clinical services for people living with HIV/AIDS. PUBLIC HEALTH RELEVANCE: Prevention strategies that aim to test and treat people for HIV infection are undermined by HIV treatment non-adherence and sexually transmitted co-infections (STI). The proposed study will test a theory-based behavioral intervention to reduce HIV infectiousness by simultaneously improving HIV treatment adherence and reducing sexually transmitted co-infections in people living with HIV-AIDS who use alcohol and other drugs. The intervention is delivered in a single office-based counseling session followed by 4 cell phone delivered counseling sessions in a model that will be ready for immediate dissemination to case management and clinical services for people living with HIV/AIDS in resource constrained settings.