Reducing HIV risk behavior in depressed and non-depressed older adults with HIV

 描述（由申请人提供）：到2020年，美国70%的HIV感染者将≥50岁，这在很大程度上是由于临床护理的改善、更有效的抗逆转录病毒治疗方案以及新诊断为HIV ≥50岁的人数不断增加。据估计，37%的性活跃的老年艾滋病毒感染者（OPLWH）继续从事艾滋病毒传播的性行为。尽管一再呼吁采取二级预防干预措施，以减少艾滋病毒/艾滋病办公室中的无安全套性行为，但对这一群体没有适合年龄的循证二级预防干预措施。由于艾滋病毒和年龄相关的耻辱感、精神和身体健康共病使前往提供艾滋病毒预防干预措施的地点变得复杂，或地理位置偏远，许多艾滋病毒/艾滋病观察员无法参与面对面的二级预防服务。OPLWH中抑郁和神经认知障碍的高发病率可能会使旨在减少该群体艾滋病毒传播的干预措施的参与进一步复杂化，并减少其益处。这项研究是一项随机对照试验，采用5次电话激励访谈加行为技能培训（teleMI+BST）干预，以减少50岁以上HIV阳性成年人的无安全套性行为。将通过为艾滋病毒感染者提供服务的社区组织、艾滋病毒社会服务提供者的农村网络、在艾滋病毒相关杂志和网站上刊登的广告以及在线约会论坛，在美国各地招募336名在地理和种族/种族上多样化的OPLWH样本。符合条件的受试者将被随机分配接受5次电话MI +BST干预或相当于5次电话管理应对有效性培训（teleCET）的注意力控制干预。研究治疗师将是位于俄勒冈州波特兰的社区HIV社会服务提供者。自我管理的问卷将评估人口统计学特征，以及安全套使用知识，信仰，态度和技能，而简短的电话访谈将评估性行为，物质使用和精神症状。还将在基线时进行电话管理的神经认知评估。研究目的1将测试teleMI+BST在减少与HIV阴性或HIV血清状态未知的伴侣进行无安全套保护的肛交和阴道性交的情况方面的有效性，并检查干预有效性的社会心理调节剂。研究目标2将测试teleMI+BST在减轻轻度抑郁受试者的抑郁症状方面的疗效。研究目的3将测试基线抑郁症状严重程度对teleMI+BST疗效的调节作用。其他探索性分析将检查参与者的性伴侣使用神经认知功能、VL和暴露前预防（PrEP）对teleMI+BST疗效的影响。这项研究可能会产生一个以证据为基础的，以人为本的干预措施，满足独特的性关系和健康需求的OPLWH和减少艾滋病毒的传播给他们的艾滋病毒阴性的性伴侣。

 DESCRIPTION (provided by applicant): By 2020, 70% of people living with HIV in the United States will be ≥50 years of age due, in large part, to improved clinical care, more efficacious antiretroviral therapy regimens, and the increasing number of persons newly diagnosed with HIV ≥50 years of age. An estimated 37% of sexually active older people living with HIV (OPLWH) continue to engage in HIV transmission sexual behaviors. In spite of repeated calls for secondary prevention interventions to reduce condomless sex in OPLWH, no age-appropriate, evidence-based secondary prevention interventions exist for this group. Many OPLWH cannot engage in face-to-face secondary prevention services because of HIV- and age-related stigma, comorbid mental and physical health conditions that complicate travel to venues in which HIV prevention interventions are delivered, or geographic isolation. High rates of depression and neurocognitive impairment in OPLWH may further complicate engagement in, and reduce benefits of, interventions that aim to reduce HIV transmissions in this group. The proposed study is a randomized controlled trial of a 5-session telephone-administered motivational interviewing plus behavioral skills training (teleMI+BST) intervention to reduce condomless sex in HIV-positive adults 50-plus years of age. A geographically and ethnically/racially diverse sample of 336 OPLWH will be recruited across the U.S. through community-based organizations that serve people living with HIV, rural networks of HIV social service providers, advertisements placed in HIV-related magazines and websites, and online dating forums. Eligible persons will be randomly assigned to receive either a 5-session teleMI+BST intervention or an attention equivalent 5-session telephone-administered coping effectiveness training (teleCET) control intervention. Study therapists will be community-based HIV social service providers located in Portland, OR. Self- administered questionnaires will assess demographic characteristics, and condom use knowledge, beliefs, attitudes, and skills, while a brief telephone interview will assess sexual behavior, substance use, and psychiatric symptoms. A telephone-administered neurocognitive assessment will also be conducted at baseline. Study Aim 1 will test the efficacy of teleMI+BST to reduce occasions of non-condom protected anal and vaginal intercourse with HIV-negative or unknown HIV serostatus partners and examine psychosocial mediators of intervention efficacy. Study Aim 2 will test the efficacy of teleMI+BST to reduce depressive symptoms in mildly depressed participants. Study Aim 3 will test the moderating effect of baseline depressive symptom severity on teleMI+BST efficacy. Additional exploratory analyses will examine the impact of neurocognitive functioning, VL, and pre-exposure prophylaxis (PrEP) use by participants' sexual partners on teleMI+BST efficacy. This study may yield an evidence-based, person-centered intervention that meets the unique sexual relationship and health needs of OPLWH and reduces the transmission of HIV to their HIV- negative sexual partners.