Brief Care-based HIV Prevention for Newly Diagnosed Men

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，需要研究确定有效的积极预防干预措施，纳入艾滋病毒初级保健机构，以减少艾滋病毒阳性个体的传播风险行为。特别是，对于那些新诊断的患者，没有有效的干预措施。艾滋病毒诊断后的一段时间可能是激励减少危险行为或维持较低风险的“教育时刻”。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，特别是对男性而言。本研究的主要目的是评估基于信息，动机和行为技能（IMB）模型的简短积极预防干预的有效性，该干预在护理和治疗新诊断的艾滋病毒阳性男男性行为（MSM）中提供，以减少传播风险行为。这项为期5年的研究将随机分配300名性活跃的HIV阳性男男性行为者，他们在前3个月内被新诊断，接受1)综合标准护理（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，旨在解决性传播风险行为和物质使用问题。BRR将跟踪初次医生就诊，并在个性化和相关医疗的背景下整合风险降低，以加强对健康保护信息的吸收。在基线、干预后（3个月）、6个月、9个月、12个月的随访点收集信息、动机影响、行为技能、性风险行为和物质使用的评估，以确定干预的结果效果。据推测，相对于新诊断的HIV阳性男性分配到比较条件（CSC），那些在BRR干预将显着降低艾滋病毒性传播风险行为的发生率，延迟发生第一次无保护的性行为，减少药物使用。随着时间的推移，IMB模型的关键要素将预测传播风险行为的减少，并将证明干预效果的中介作用。如果成功，这项研究将确定一种简短的积极预防干预措施，可以在新诊断出艾滋病毒的男性的护理环境中实施。

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.