A comprehensive approach to secondary HIV prevention and care among positives

描述（由申请人提供）：此申请是对R01DA032217-01的修订。随着美国艾滋病毒血清阳性人数的增加，需要增加二级预防和优化初级艾滋病毒医疗保健。由于许多血清阳性患者不知道自己的血清状态，因此也需要增加针对高危人群的VCT项目。我们之前以社会网络为导向的干预措施已经证明了风险降低的扩散和招募血清阳性注射吸毒者（IDUs）的能力。鉴于注射吸毒者中艾滋病毒的性传播率和耐药程度高，以及注射吸毒的慢性性质，需要有效的行为干预策略，以解决注射吸毒者及其风险网络成员之间的风险行为，这些行为可以持续。此外，迫切需要制定方案，让艾滋病毒/艾滋病感染者（PLHAs）参与并保留初级艾滋病毒医疗保健。参与艾滋病毒初级保健已被发现可以预测病毒学和临床结果。与其他艾滋病毒种族或暴露群体相比，非洲裔美国人和注射吸毒者的艾滋病毒发病率和死亡率较高，且参与艾滋病毒初级保健的程度低且不一致。基于我们之前的干预措施，本研究的主要目标是培训IDU PHLAs成为同伴健康教育者，将(1)为VCT招募高风险网络成员，(2)促进网络风险降低，(3)通过鼓励其HIV血清阳性网络成员安排和遵守HIV初级保健预约，现实的患者-提供者角色期望，以及讨论HIV医疗保健的社会规范，促进参与HIV护理和治疗。我们建议招募并随机分配300名IDUs plha（称为指数）中的一半，主要是非裔美国人，进行实验性同伴健康教育者培训，另一半进行注意力控制条件。两种情况下的参与者都将被鼓励为VCT招募高风险网络成员。我们预计将有270家网络注册。为了提高干预效果的可持续性，将为实验参与者及其网络成员提供艾滋病毒护理支持会议。我们期望同伴健康教育者的角色将被认为对注射吸毒者是有意义的，他们很少有机会扮演亲社会角色，社会奖励将有助于维持同伴健康教育和干预效果的社会扩散。而且这

DESCRIPTION (provided by applicant): This application is a revision to R01DA032217-01. With the growing number of HIV seropositives in the US, there is a need for increasing secondary prevention and optimizing primary HIV medical care. As many seropositives are unaware of their serostatus there is also a need for increased VCT programs that reach high risk individuals. Our prior social network oriented interventions have demonstrated diffusion of risk reduction and the ability to recruit seropositive injection drug users (IDUs). Given the substantial rates of sexual HIV transmission and high levels of drug resistant HIV among IDUs, as well as the chronic nature of injection drug use, there is a need for effective behavioral intervention strategies that address risk behaviors among IDUs and their risk network members that can be sustained.. There is also an urgent need to develop programs to engage and retain vulnerable drug using people living with HIV/AIDS (PLHAs) in primary HIV medical care. Engagement in HIV primary care has been found to predict virologic and clinical outcomes. Low and inconsistent engagement in HIV primary care contributes to African Americans' and IDUs' higher HIV morbidity and mortality rates compared to other HIV racial or exposure groups. The main goal of the proposed study, which builds on our prior interventions is to train IDU PHLAs to be peer health educators will (1) recruit high risk network members for VCT, (2) promote network risk reduction, and (3) promote engagement in HIV care and treatment by encouraging their HIV seropositive network members to schedule and keep HIV primary care appointments, realistic patient-provider role expectations, and social norms of discussing HIV medical care. We propose recruiting and randomly assigning half of 300 IDUs PLHAs (termed indexes), predominantly African American, to an experimental peer health educator training and half to an attention control condition. Participants in both conditions will be encouraged to recruit high ris network members for VCT. We anticipate 270 networks will enroll. To enhance sustainability of intervention effects, experimental participants and their network members will be offered support sessions on HIV care. We expect that the peer health educator role will be perceived as meaningful to IDUs, who have minimal opportunities for prosocial roles, and that social rewards will help sustain peer health education and social diffusion of intervention effects. Moreover this approach can provide PLHA with training in goal setting, problem solving, and communication skills that can be applied to personal and professional situations.