PHYSICIAN DELIVERED INTERVENTION FOR HIV+ INDIVIDUALS

尽管在HIV+人群中记录了高水平的此类行为，尽管为HIV+人群开发有效的降低风险干预措施已被确定为NIH的首要任务，但人们对减少HIV+人群中的HIV风险行为的了解相对较少。迫切需要设计有效的干预措施，以减少艾滋病毒感染者的高风险行为，因为从事危险行为的艾滋病毒感染者是未受感染的性伴侣和共用针头伴侣的艾滋病毒风险的某些来源，并可能将耐药的艾滋病毒菌株和其他病原体传播给艾滋病毒感染者，而且本身也容易通过高风险行为与其他病原体（例如性传播疾病）共同感染。此外，在目前高效抗逆转录病毒治疗（HAART）的时代，减少艾滋病毒阳性者的高危行为尤为重要。由于高效抗逆转录病毒疗法可大大延长艾滋病毒阳性者的健康和寿命，它也提供了在较长时间内将艾滋病毒传染给他人的可能性，因此可能加强对抗逆转录病毒疗法（例如AZT、3TC和可能的高效抗逆转录病毒疗法）具有耐药性的菌株的传播。本研究应用HIV风险行为改变的信息-动机-行为技能（IMB）模型来设计一种医生提供的干预措施，以减少在HIV治疗环境中接受护理的HIV阳性成年男性和女性的HIV风险行为。艾滋病毒的标准治疗需要定期和频繁地到临床护理机构就诊，这往往导致密切的医患关系。因此，这一环境是对艾滋病毒阳性个体进行预防干预的极其有力的环境。这项研究将在两个非常相似的艾滋病毒诊所进行，这两个诊所总共治疗了1800多名H1V+成年人。一个诊所作为干预点，一个作为对照点。干预措施将由一组经验丰富的行为科学家和艾滋病毒临床研究人员设计和实施。本研究项目的总体目标是设计、实施和严格评估一种基于概念的、易于传播的、临床医生提供的干预措施，以促进在艾滋病毒治疗环境中接受护理的艾滋病毒阳性成人降低艾滋病毒风险。这一人群面临着将艾滋病毒传染给其他艾滋病毒感染者以及自身感染其他病原体的巨大风险，对这一人群来说，几乎没有任何有效的艾滋病毒风险降低干预措施。

Relatively little is known about reducing HIV risk behavior among HIV+ persons, despite the fact that high levels of such behavior have been documented within the HIV+ population, and despite the fact that development of effective risk reduction interventions for HIV+ persons has been identified as a top NIH priority. The need to design effective interventions to reduce high risk behaviors among HIV+ individuals is pressing, since HIV+ persons who practice risky behaviors are certain sources of HIV risk to uninfected sexual and needle-sharing partners, and may transmit treatment resistant strains of HIV and other pathogens to HIV+ partners, and are themselves vulnerable to coinfection with other pathogens (e.g., STDs) through high risk behavior. Moreover, reducing high risk behavior among HIV+ persons is especially critical in the current era of highly active antiretroviral therapy (HAART). Because HAART may result in greatly increased health and lifespan for HIV+ persons, it also affords the possibility of transmitting HIV to others over greatly extended periods of time and may therefore enhance transmission of strains resistant to antiretroviral therapies (e.g., AZT, 3TC, and possibly HAART). The proposed research applies the Information--Motivation--Behavioral Skills (IMB) model of HIV risk behavior change to design a physician- delivered intervention to reduce HIV risk behavior among HIV+ adult men and women receiving care in HIV treatment settings. Standard treatment for HIV necessitates regular and frequent visits to clinical care settings, often resulting in close patient-clinician relationships. Thus, this setting is an exceedingly powerful context for prevention interventions for HIV+ individuals. The study will be conducted at two very comparable HIV clinics which together treat over 1800 H1V+ adults. On clinic will serve as an intervention site and one as a control site. The intervention will be designed and conducted by an experienced group of behavioral scientists and HIV clinical researchers. The overall goal of this program of research is to design, to implement, and to rigorously evaluate a conceptually based, easily disseminated, clinician- delivered intervention to promote HIV risk reduction among HIV+ adults receiving care in HIV treatment settings. This population is at enormous risk for transmitting HIV to others who are HIV-, and for acquiring other pathogens themselves and it is a population for whom there are few if any effective HIV risk reduction interventions.