Repeat STI Patients: Tailored Socio-Contextual Intervention to Reduce HIV Risk

描述(由申请人提供)：反复的性传播感染(STI)，如衣原体、淋病、滴虫病和梅毒，表明艾滋病毒的风险活动持续增加，反复的STI感染增加了暴露期间艾滋病毒传播的可能性。重复的性传播感染患者占公共性传播感染门诊就诊的很大比例。根据定义，寻求再次感染STI的患者没有得到STI诊所目前提供的预防服务的充分服务，并可能受益于额外的以诊所为基础的服务，以降低他们未来感染STI和艾滋病毒的风险。艾滋病毒预防领域在很大程度上对帮助复发性性传播感染患者保持沉默；没有公开发表的研究专门测试针对这一人群的干预措施。此外，大多数基于性传播感染诊所的艾滋病毒风险降低干预研究直接集中在性危险行为的存在问题上，最多在一项研究中解决另一个相关因素，如共存的抑郁或药物使用，而很明显，重复的性传播感染是由广泛的背景因素驱动的。可能需要新的、个性化的干预方法来帮助复发性传播感染患者降低他们感染艾滋病毒和感染其他人的风险。我们建议通过开发和测试基于社会行动理论(Ewart，1991)的个体定制的基于优势的预防病例管理干预策略来解决先前研究的这些局限性，该策略解决了重复STI患者的社会背景和在这些患者中增加STI和HIV风险的其他因素。这项研究将分两个阶段进行。在项目的最初12-15个月内，我们将致力于在威斯康星州密尔沃基市对重复性传播感染现象进行形成性研究，这是一个性传播感染发病率较高且不断上升的城市，并将致力于制定和试点干预方案。我们的形成工作将由三个主要要素组成。首先，我们将对重复感染的STI患者进行定性访谈，以更好地了解导致他们再次感染的因素，以及他们认为哪些服务可以帮助他们避免未来的感染。其次，我们将开发一种以临床为基础的个性化干预措施，以降低STI复发者的风险。第三，我们将对干预的可行性和可接受性进行试验。在该项目的第二阶段，我们将在12个月内对250名男性和250名女性进行一项完全随机的临床试验，他们在诊所就诊时有两次或更多的性传播感染。我们将在招募后对试验组和对照组(临床标准护理)的参与者进行为期12个月的跟踪调查，以检查干预对于性危险活动、重复性传播感染和其他有益健康的影响。最后，对干预措施进行成本和成本效果分析。

DESCRIPTION (provided by applicant): Repeat sexually transmitted infections (STI), such as Chlamydia, gonorrhea, trichomoniasis, and syphilis indicate persistent elevated risk activity for HIV, and repeated STI infections increase the likelihood of HIV transmission during exposure. Repeat STI patients represent a significant proportion of public STI clinic visits. Patients who seek treatment for repeat STI infections, by definition, are not adequately served by the prevention services currently provided by STI clinics, and may benefit from additional clinic-based services to reduce their risk of future infections of STI and HIV. The HIV prevention field has largely been silent about assisting repeat STI patients; there are no published studies testing interventions specifically for this population. In addition, most HIV risk-reduction intervention research based in STI clinics has focused directly on the presenting problem of sexual risk behavior, at most addressing one other related factor, such as co- existing depression or substance use, in a single study, whereas it is clear that repeat STI is driven by a wide range of contextual factors. Novel, individually tailored intervention approaches are likely needed to help repeat STI patients reduce their risk of HIV infection and infecting others. We propose to address these limitations of previous research by developing and testing an individually-tailored strengths-based prevention case management intervention strategy based on Social Action Theory (Ewart, 1991) that addresses repeat STI patients' social context and other factors that heighten STI and HIV risk among these patients. This research will be conducted in two phases. During the first 12-15 months of the project, our efforts will be devoted to conducting formative research on the phenomenon of repeat STI in Milwaukee, WI, a city with high and rising rates of STI, and on developing and piloting the intervention protocol. Our formative work will consist of three major elements. First we will conduct qualitative interviews with a sample of repeat STI patients to better understand the factors that lead to their repeated infection and what services they believe could help them avoid future infections. Second, we will develop an individually tailored clinic-based intervention to reduce risk among repeat STI patients. Third, we will conduct a feasibility and acceptability trial of the intervention. In the second phase of the project, we will conduct a full randomized clinical trial with 250 men and 250 women attending the clinic with two or more STI in a 12 month period. We will follow participants in the experimental group and the control group (clinic standard care) for 12 months following recruitment to examine the effects of the intervention on sexual risk activity, repeat STI, and other beneficial health effects. Finally, we will conduct a cost and cost-effectiveness analysis of the intervention.