HIV Prevention for STD Clinic Patients

描述（由申请人提供）：本研究的广泛、长期目标是降低艾滋病毒引起的发病率和死亡率。具体目标是为在性传播疾病诊所寻求治疗的患者制定和评估降低风险的干预措施。这项研究将分为两个阶段。首先，将对100名性病门诊患者进行形成性研究，以澄清贫困城市环境中风险行为（和风险降低）的决定因素。所获得的信息将与行为科学理论相结合，以制定可以通过数字视频光盘（DVD）提供的降低性风险的干预措施。预计DVD将向患者提供有关艾滋病毒/性传播疾病的信息，激发患者避免风险的动机，提高减少风险所必需的内部和人际技能，并提供详细的疾病预防策略。DVD将采用激励风格，根据性别和性取向量身定制，并采用戏剧和说教成分，以优化个人相关性。其次，将进行一项随机对照试验，纳入1000名性病门诊患者，以：（a）评估DVD的有效性，（B）将DVD的效果与详细的性行为评估的效果分开。患者将被随机分配到通过交叉评估内容（详细的性行为与一般健康行为）和干预重点（性风险降低与一般健康促进）形成的四种情况之一。患者完成基线评估后，他们将接受基于DVD的干预和标准临床护理。在3、6、9和12个月时，他们将提供性行为自我报告和性病检测标本。分析将测试与观看一般健康促进DVD的患者相比，观看性健康DVD的患者是否减少了更多的风险行为，并减少了新的性病。还将进行分析，以增加对干预措施的个体差异的了解。总的来说，拟议的研究将确定DVD提供的降低风险信息是否可以减少性风险行为和性病事件。如果发现有效，这种DVD可以为全国性病诊所提供一个高度可行、易于传播的降低风险计划。此外，该研究还将调查性风险降低研究中常见的详细基线性行为评估是否真的促进了性行为的改变。澄清研究评估的影响对于解释干预文献和指导公共卫生实践至关重要。最后，通过确定那些没有从这些干预措施中受益的患者，这项研究可以为无应答者的干预措施改进提出建议。这项研究将推动发展实用和有效的减少性风险的干预措施，用于性病诊所，从而减少艾滋病毒和其他性病造成的疾病负担。 公共卫生相关性：这项拟议中的研究将帮助性传播疾病（STD）诊所的患者降低感染艾滋病毒和其他性病的风险。研究的初始阶段将涉及开发一种可以通过数字视频光盘（DVD）管理的降低艾滋病毒风险的干预措施。在开发DVD后，将对1000名患者进行随机对照研究，以确定DVD管理的干预是否有助于患者减少性风险行为并预防新的性病。这项研究将导致开发一个实用的，有效的，易于分发的性风险降低干预在公共性病诊所使用。

DESCRIPTION (provided by applicant): The broad, long-term objective of this research is to reduce the morbidity and mortality caused by HIV. The specific aims are to develop and evaluate a risk reduction intervention for patients seeking care at sexually transmitted disease (STD) clinics. This research will have two phases. First, formative research will be conducted with 100 STD clinic patients to clarify the determinants of risk behavior (and risk reduction) in impoverished urban environments. Information obtained will be integrated with behavioral science theory to develop sexual risk reduction interventions that can be delivered by digital video disc (DVD). It is expected that the DVDs will provide patients with information about HIV/STDS, activate patients' motivation to avoid risk, enhance the intra- and interpersonal skills essential for risk reduction, and provide detailed disease prevention strategies. The DVDs will employ a motivational style, be tailored by sex and sexual orientation, and employ dramatic as well as didactic components in order to optimize personal relevance. Second, a randomized controlled trial with 1000 STD clinic patients will be conducted to: (a) evaluate the effectiveness of the DVDs, and (b) separate the effects of the DVDs from the effects of detailed sexual behavior assessments. Patients will be randomized to one of four conditions formed by crossing assessment content (detailed sexual behavior vs. general health behavior) with intervention foci (sexual risk reduction vs. general health promotion). After patients complete a baseline assessment, they will receive a DVD-based intervention and standard clinical care. At 3, 6, 9, and 12 months, they will provide sexual behavior self-reports and specimens for STD testing. Analyses will test whether patients who view the sexual health DVD reduce risk behavior more and have fewer new STDs compared to patients who view a general health promotion DVD. Analyses will also be conducted to increase understanding of individual differences in response to the interventions. Overall, the proposed research will determine whether risk reduction messages delivered by DVD can reduce sexual risk behavior and incident STDs. If found effective, such DVDs can provide a highly feasible, easily disseminated risk reduction program for STD clinics nationwide. In addition, the research will investigate whether the detailed baseline sexual behavior assessments that are common to sexual risk reduction research actually promote sexual behavior change. Clarifying the effects of research assessments is essential to interpreting the intervention literature, and guiding public health practice. Finally, by identifying patients who do not benefit from these interventions, this research can suggest directions for intervention refinement for non-responders. This research will advance the development of practical and effective sexual risk reduction interventions for use in STD clinics, and thereby reduce the burden of disease caused by HIV and other STDs. PUBLIC HEALTH RELEVANCE: The proposed research will help patients at sexually transmitted disease (STD) clinics to reduce their risk for HIV and other STDs. The initial phase of research will involve developing a HIV risk reduction intervention that can be administered with a digital video disc (DVD). After developing the DVD, a randomized controlled research study will be conducted with 1000 patients to determine if the DVD-administered intervention helps patients to reduce sexual risk behavior and prevent new STDs. This study will lead to the development of a practical, effective, and easily-distributed sexual risk reduction intervention for use in public STD clinics.