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: 7862343
• 负责人: KATHLEEN J SIKKEMA
• 金额: $ 71.75万
• 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 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7862343
• 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; 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; randomized trial; 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、性传播感染和危险行为的增加表明，需要进行研究来确定在艾滋病毒初级保健机构中纳入有效的积极预防干预措施，以减少艾滋病毒阳性个体中的传播危险行为。特别是，对于新诊断的患者，尚无有效的干预措施。 HIV诊断后的一段时间可能是一个“教育时刻”，可以激励人们减少危险行为或维持较低的风险。这是一个机会之窗，因为收到艾滋病毒诊断后的第一年可能是降低风险的关键时期，尤其是对于男性而言。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措施的效果，该干预措施在新诊断的男男性行为者 (MSM) 艾滋病毒阳性男性 (MSM) 的护理和治疗中提供，以减少传播风险行为。拟议的五年研究将随机分配 300 名在前 3 个月内新诊断的性活跃、HIV 阳性 MSM，接受 1) 综合护理标准 (CSC) 或 2) 短期风险降低 + 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药物使用问题。 BRR 将在初次就诊后将风险降低纳入个性化和相关医疗治疗的背景下，以提高健康保护信息的吸收率。将在基线、干预后 (3-) 和 6、9、12 个月的随访点收集信息、动机影响、行为技能、性危险行为和物质使用的评估，以确定干预结果效果。据推测，相对于分配到比较条件（CSC）的新诊断的 HIV 阳性男性，接受 BRR 干预的男性将表现出显着较低的 HIV 性传播风险行为发生率、延迟首次无保护性行为的发生以及减少物质使用。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。 公共卫生相关性 需要进行研究来确定有效的积极预防干预措施，这些干预措施可以整合到艾滋病毒治疗环境中，以减少艾滋病毒阳性个体的危险行为。这项研究将首次评估短暂的风险降低干预措施，以减少新诊断出艾滋病毒的男性中的传播风险行为，对于艾滋病毒+诊断后的早期干预是否能最大限度地提高降低风险的“教育时刻”具有科学意义。拟议的干预研究具有重要意义，并且与公共卫生高度相关，这主要是因为针对新诊断人群的重要性。 HIV 诊断后的早期干预侧重于由于适应诊断时风险行为水平波动而可能增加 HIV 传播可能性的时间段，提供了在了解 HIV+ 状态后维持风险降低的机会，并通过将风险降低纳入多学科护理方法中，协助向医疗护理过渡。