Brief Care-based HIV Prevention for Newly Diagnosed Men

针对新诊断男性的简要护理型艾滋病毒预防

• 批准号: 7545669
• 负责人: KATHLEEN J SIKKEMA
• 金额: $ 72.21万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-08 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7545669
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Alcohol or Other Drugs use; Anus; Behavioral; Caring; Case Management; Clinic; Communities; Community Health Centers; Diagnosis; Elements; Enrollment; Epidemic; Evidence based intervention; Exhibits; Frequencies; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health Promotion; Human immunodeficiency virus test; Individual; Intervention; Intervention Studies; Intervention Trial; Knowledge; Learning; Maintenance; Mediation; Mediator of activation protein; Medical; Mental Health Services; Modeling; Motivation; Newly Diagnosed; Nurses; Outcome; Participant; Patients; Persons; Physicians; Prevention; Preventive Intervention; Primary Health Care; Professional counselor; Public Health; Randomized; Randomized Controlled Clinical Trials; Relative (related person); Reporting; Request for Applications; Research; Risk; Risk Behaviors; Risk Reduction; Risk Reduction Behavior; Sex Behavior; Sexual Transmission; Sexually Transmitted Diseases; Testing; Time; Translating; Unsafe Sex; Visit; base; behavior change; behavior influence; brief intervention; catalyst; critical period; effective intervention; follow-up; interdisciplinary approach; intervention effect; meetings; men; men who have sex with men; post intervention; prevent; primary care setting; programs; prospective; psychosocial; public health relevance; sex risk; sexually active; skills; standard care; standard of care; transmission process; uptake

DESCRIPTION (provided by applicant): Recent increases in HIV diagnoses, sexually transmitted infections, and risk behavior indicate that research is needed to identify effective positive prevention interventions integrated within HIV primary care settings to reduce transmission risk behavior among HIV positive individuals. In particular, no effective interventions exist for those newly diagnosed. The time period after HIV diagnosis may be a `teachable moment' to motivate reductions in risk behavior or maintenance of lower risk. This is a window of opportunity, as the first year after receiving an HIV diagnosis may be a critical period for risk reduction, especially for men. The primary objective of this study is to evaluate the efficacy of a brief positive prevention intervention, based on the Information, Motivation and Behavioral Skills (IMB) Model, provided within the care and treatment of newly diagnosed HIV-positive men who have sex with men (MSM) to reduce transmission risk behavior. The proposed five-year study will randomly assign 300 sexually active, HIV- positive MSM, newly diagnosed within the prior 3 months, to receive either 1) comprehensive standard of care (CSC) or 2) Brief Risk Reduction + CSC (BRR), a brief individual intervention based on the IMB model that addresses sexual transmission risk behavior and substance use. BRR will follow the initial physician visit and integrate risk reduction in the context of personalized and relevant medical treatment to enhance the uptake of health-protective information. Assessments of information, motivational influences, behavioral skills, sexual risk behavior, and substance use will be collected at baseline, post-intervention (3-), and 6-, 9-, 12- month follow-up points to determine intervention outcome effects. It is hypothesized that, relative to newly diagnosed HIV- positive men assigned to the comparison condition (CSC), those in the BRR intervention will exhibit significantly lower rates of HIV sexual transmission risk behavior, delayed onset to first unprotected sexual activity, and reduced substance use. Over time, reductions in transmission risk behaviors will be predicted by key elements of the IMB model and will demonstrate mediation of intervention effects. If successful, this research will identify a brief positive prevention intervention that can be implemented in the care setting for newly HIV diagnosed men. PUBLIC HEALTH RELEVANCE Research is needed to identify effective positive prevention interventions that can be integrated within HIV treatment settings to reduce risk behavior among HIV positive individuals. This research will be the first to evaluate a brief risk reduction intervention to reduce transmission risk behavior among newly HIV diagnosed men, with scientific relevance regarding whether intervening early after an HIV+ diagnosis maximizes a `teachable moment' for risk reduction. The proposed intervention research is significant and highly relevant to the public health, due primarily to the importance of targeting those newly diagnosed. Intervening early after the HIV diagnosis focuses on a time period that may have increased likelihood of HIV transmission due to fluctuating levels of risk behavior as one adjusts to the diagnosis, provides an opportunity to maintain risk reduction initiated after learning of HIV+ status, and assists in the transition to medical care through inclusion of risk reduction in a multidisciplinary approach to care.

描述（由申请人提供）：最近艾滋病毒诊断，性传播感染和风险行为的增加表明，需要进行研究，以确定有效的积极预防干预措施，整合在艾滋病毒初级保健环境中，以减少艾滋病毒阳性个体之间的传播风险行为。特别是，对于那些新诊断的人没有有效的干预措施。艾滋病毒诊断后的一段时间可能是一个“可教的时刻”，以激励减少风险行为或维持较低的风险。这是一个机会之窗，因为接受艾滋病毒诊断后的第一年可能是减少风险的关键时期，特别是对男子而言。本研究的主要目的是评估一个简短的积极的预防干预的有效性，信息，动机和行为技能（IMB）模型的基础上，提供的护理和治疗新诊断的艾滋病毒阳性的男性与男性发生性关系（MSM），以减少传播风险行为。这项为期五年的研究将随机分配300名性活跃的HIV阳性MSM，在过去3个月内新诊断，接受1）全面标准护理（CSC）或2）简短风险降低+ CSC（BRR），这是一种基于IMB模型的简短个人干预，解决性传播风险行为和物质使用。BRR将遵循最初的医生访问，并在个性化和相关医疗的背景下整合风险降低，以提高健康保护信息的吸收。将在基线、干预后（3-）和6个月、9个月、12个月随访时收集信息、动机影响、行为技能、性风险行为和物质使用的评估，以确定干预结果的影响。据推测，相对于分配到比较条件（CSC）的新诊断的HIV阳性男性，BRR干预中的那些人将表现出显著较低的HIV性传播风险行为率，延迟首次无保护性活动的发生，以及减少物质使用。随着时间的推移，传播风险行为的减少将通过IMB模型的关键要素进行预测，并将证明干预效果的中介作用。如果成功，这项研究将确定一个简短的积极预防干预措施，可以在护理环境中实施新诊断的艾滋病毒男性。 公共卫生相关性研究是必要的，以确定有效的积极预防干预措施，可以整合在艾滋病毒治疗环境中，以减少艾滋病毒阳性个体的风险行为。这项研究将是第一个评估一个简短的降低风险的干预措施，以减少新诊断的艾滋病毒感染者的传播风险行为，与科学相关性是否干预后，艾滋病毒+诊断最大化的风险降低的“可教的时刻”。拟议的干预研究是重要的，高度相关的公共卫生，主要是由于针对那些新诊断的重要性。艾滋病毒诊断后早期干预的重点是一段时间内，可能会增加艾滋病毒传播的可能性，由于风险行为的波动水平，因为一个调整的诊断，提供了一个机会，以保持风险降低后启动的艾滋病毒+状态的学习，并协助过渡到医疗保健，通过纳入风险降低多学科的方法来照顾。