Client-Centered Counseling During Routine/Opt-Out HIV-Testing in Uganda

乌干达常规/退出艾滋病毒检测期间以客户为中心的咨询

• 批准号: 7803696
• 负责人: Susan Maria Kiene
• 金额: $ 15.85万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7803696
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adopted; Adult; Advocate; Affect; Area; Award; Behavior; Behavioral; Behavioral Sciences; Biological; Biological Markers; Caring; Client; Cognitive; Communities; Counseling; Country; Data; Discipline; Disinhibition; Effectiveness; Epidemic; Fatigue; Feedback; Future; Goals; Government; HIV; HIV Seropositivity; Health; Health Personnel; Health care facility; Hospitals; Human immunodeficiency virus test; Incidence; Individual; Infection; Infectious Disease Epidemiology; International; Intervention; Intervention Trial; Knowledge; Literature; Medical; Mentors; Methods; Outcome; Outpatients; Paint; Patient Self-Report; Patients; Persons; Population; Prevalence; Prevention; Prevention Research; Prevention approach; Prevention strategy; Preventive; Preventive Intervention; Primary Prevention; Principal Investigator; Procedures; Process; Provider; Public Health; Randomized Controlled Trials; Recommendation; Request for Applications; Research; Research Personnel; Research Support; Resources; Risk; Risk Behaviors; Risk Reduction; Risk Reduction Behavior; Roentgen Rays; Rural Hospitals; Secondary Prevention; Services; Sex Behavior; Sexual Partners; Sexually Transmitted Diseases; Structure; Testing; Time; Training; Uganda; base; behavior change; career; clinical care; cohort; condoms; cost; direct application; experience; high risk sexual behavior; mortality; multidisciplinary; novel strategies; prevent; programs; psychosocial; response; routine care; scale up; sex risk; skills; social; stem; success; theories; therapy design; transmission process; uptake

DESCRIPTION (provided by applicant): The applicant's long-term goal is to build a career as an independent investigator in multidisciplinary international health research focusing on HIV/AIDS research in resource-limited settings to help reduce the global HIV epidemic. In this award the candidate will build on her behavioral science background by developing knowledge and skills in public health, epidemiology, and infectious diseases with direct applications to international HIV/AIDS prevention research. The goals of this mentored award are to obtain training in these disciplines, gain expertise in methods and analysis for using biological outcomes in intervention trials, and experience conducting international HIV prevention research. The proposed research program will adapt an effective theory-based brief client-centered prevention for positives intervention designed to decrease risky sexual behavior (the OPTIONS Project), to the primary prevention setting of outpatient routine/opt-out HIV testing and counseling (RTC) in Uganda. Uganda is one of the countries most affected by the HIV epidemic and approximately 80% of those who are HIV-positive are unaware of their status. In an effort to address this situation, Uganda is expanding RTC programs. The structure and content of counseling during RTC differs dramatically from that offered during opt-in HIV-testing. Recommendations for counseling during RTC call for abandoning the client-centered counseling approach advocated in opt-in testing, in place of providing brief information and referrals for support and care services. Furthermore, unlike other HIV-counseling and testing programs, RTC places little emphasis on reducing sexual risk behavior, which is a missed opportunity for prevention. The aims of the research are: 1) conduct formative research to understand the dynamics of sexual risk behavior and elicit recommendations for adapting the intervention, 2) adapt, pilot-test, and refine the brief client-centered RTC intervention, and 3) investigate behavior change processes following RTC to identify psychosocial, social-cognitive and behavioral factors that explain short and long term sexual risk behavior change. The research will also explore the concordance between self- report and biological markers of unprotected sexual behavior and estimate the potential effect size of the brief client-centered RTC intervention on preventing new sexually transmitted infections (STIs). The proposed research will prepare the candidate to test the effects of the resultant intervention on reducing STI incidence and risky sexual behavior in a future large randomized controlled trial. This research is especially timely in Uganda and elsewhere as RTC is being scaled up. If a future trial of the proposed intervention shows it to be an effective HIV-prevention approach it is well situated to be adopted as the standard-of-care for RTC in Uganda and hopefully throughout the world as well.

描述（由申请人提供）：申请人的长期目标是建立一个职业生涯作为一个独立的研究人员在多学科的国际卫生研究，重点是艾滋病毒/艾滋病研究在资源有限的设置，以帮助减少全球艾滋病毒流行。在这个奖项中，候选人将通过发展公共卫生，流行病学和传染病方面的知识和技能来建立她的行为科学背景，并直接应用于国际艾滋病毒/艾滋病预防研究。该指导奖的目标是获得这些学科的培训，获得在干预试验中使用生物学结果的方法和分析方面的专业知识，以及进行国际艾滋病毒预防研究的经验。拟议的研究计划将适应一个有效的基于理论的简短的以客户为中心的预防积极干预，旨在减少危险的性行为（OPTIONS项目），在乌干达的门诊常规/选择退出艾滋病毒检测和咨询（RTC）的初级预防设置。乌干达是受艾滋病毒流行影响最严重的国家之一，大约80%的艾滋病毒阳性者不知道自己的状况。为了解决这一问题，乌干达正在扩大RTC方案。RTC期间咨询的结构和内容与自愿参加艾滋病毒检测期间提供的咨询有很大不同。RTC期间的咨询建议要求放弃以客户为中心的咨询方法，而不是提供简短的信息和转介的支持和护理服务。此外，与其他艾滋病毒咨询和检测项目不同，RTC很少强调减少危险性行为，这是一个错失的预防机会。本研究的目的是：1）进行形成性研究，了解性风险行为的动态，并提出调整干预措施的建议，2）调整，试点测试，并完善以客户为中心的简短RTC干预措施，3）调查RTC后的行为变化过程，以确定解释短期和长期性风险行为变化的心理社会，社会认知和行为因素。该研究还将探讨自我报告与无保护性行为的生物标志物之间的一致性，并估计以客户为中心的短期RTC干预对预防新的性传播感染（STI）的潜在影响。拟议的研究将准备候选人在未来的大型随机对照试验中测试由此产生的干预措施对降低STI发病率和危险性行为的影响。这项研究在乌干达和其他地方特别及时，因为RTC正在扩大规模。如果未来对拟议干预措施的试验表明它是一种有效的艾滋病毒预防方法，那么它就很有可能被采纳为乌干达RTC的护理标准，希望在全世界也是如此。