Prevention among HIV+ Crack Users in the Hospital

说明（由申请人提供）：艾滋病毒预防信息通常针对未感染的高危人群，并侧重于预防感染艾滋病毒。最近，艾滋病毒预防领域的一个转变认识到为艾滋病毒阳性个体制定干预战略的重要性，因为每一个新的感染都是从已经感染艾滋病毒的人开始的。先前的研究表明，许多hiv阳性个体继续从事不安全的危险行为，而快客使用与这些危险行为显着相关。这些数据还表明，快客使用与使用初级门诊艾滋病毒护理负相关。医院或住院病房可能是一个重要的，但在很大程度上尚未开发的环境，为高风险的艾滋病毒阳性可卡因使用者提供预防干预措施。医院还为受感染的快客使用者提供艾滋病毒预防干预措施的重要场所，因为住院治疗可作为患者接受行为改变干预措施的“教育时刻”。

DESCRIPTION (provided by applicant): HIV prevention messages have typically targeted uninfected, at-risk individuals and have focused on forestalling the acquisition of HIV. Recently, a shift in the HIV prevention field has recognized the importance of developing intervention strategies for HIV-positive individuals, since each new infection begins with someone who is already HIV-infected. Prior studies show that many HIV-positive individuals are continuing to engage in unsafe risk behaviors and that crack use is significantly associated with these risk behaviors. These data also show that crack use is negatively associated with the use of primary outpatient HIV care. The hospital or inpatient ward may be an important, yet largely untapped setting to provide prevention interventions to high-risk, HIV-positive crack users. Hospitals also provide an important setting for HIV prevention interventions with infected crack users, because hospitalization may serve as a "teachable moment" when patients are open to behavioral change interventions. Our multi-site study between the University of Miami and Emory University will be conducted at Jackson Memorial Hospital in Miami, Florida and Grady Memorial Hospital in Atlanta, Georgia. We will evaluate the efficacy of a brief, theoretically-guided, "Prevention Care Advocate" intervention with HIV-positive crack users recruited from the HIV inpatient hospital wards at Jackson and Grady hospitals. We will provide a multicomponent, skills-building intervention that encourages participants to advocate for prevention and receipt of primary care services for themselves and their peers. These intervention strategies are adapted from strategies recently developed and tested in previous CDC-funded multi-site studies. We will employ a randomized experimental design to compare the intervention's efficacy with an attention-control group. Participants will be assessed at baseline and 6 and 12 months after completing the intervention. The primary outcome of the study will be to reduce unprotected sex. Secondary outcomes will include increasing the use of HIV primary outpatient cars and increasing readiness for and entry to drug treatment.