Positive Choice: Prevention for Positive Health

描述（由申请人提供）：药物滥用和危险的性行为会极大地损害艾滋病毒/艾滋病患者及其性伴侣的健康。为了支持艾滋病毒感染者改变这些危险行为，必须在卫生保健环境中制定和实施创新的预防干预措施，以最大限度地发挥卫生保健提供者的作用，而不增加他们的负担。这些干预措施必须始终如一地评估个人的风险，并使用最新的行为改变策略进行干预。使用多媒体技术的计算机程序在评估患者风险、向高危、治疗不足的人群提供简短的激励性干预以及激活提供者提供预防信息方面具有很大的前景。我们建议开发积极的选择，干预涉及多媒体节目，供应商和患者的教育，和供应商提示。多媒体节目的特点是一个视频医生谁评估病人的物质使用和性风险，并提供了一个简短的动机减少风险干预适合病人的准备改变和风险概况。简短的动机干预包括个性化的反馈，量身定制的建议信息，提示表，同伴建模，印刷和多媒体信息。提供者提示表将总结每位患者的风险，并建议有针对性的风险降低信息，以加强行为改变。积极选择干预可以无缝地整合到艾滋病毒感染者的初级保健中。在两家公立医院的HIV门诊中报告药物滥用（酒精和/或药物滥用）和/或无保护性行为的HIV阳性患者将入组随机对照试验。干预组的患者将接受简短的动机干预，他们的提供者将在基线和6个月时再次收到提示表。我们将在6个月和12个月的随访中确定积极选择干预是否会增加患者与提供者讨论风险的比率，增加患者对药物滥用咨询的接受程度，并减少性风险行为。如果证明有效，积极选择可以在其他卫生保健环境中实施，以改善艾滋病毒阳性者的健康状况，减少艾滋病毒的传播。

DESCRIPTION (provided by applicant): Substance abuse and sexual risky behaviors can greatly compromise the health of people with HIV/AIDS and their sexual partners. To support HIV-infected individuals in changing these risk behaviors, innovative preventive interventions must be developed and implemented in health care settings in a way that maximizes the role of health care providers without increasing their burden. These interventions must consistently assess for individuals' risks and intervene using the latest strategies for behavior change. Computer programs using multimedia technology hold great promise for assessing patient risk; delivering brief motivational interventions to at-risk, under-treated populations; and activating providers to give prevention messages. We propose to develop Positive Choice, an intervention involving a multimedia program, provider and patient education, and provider cueing. The multimedia program features a video doctor who assesses patients' substance use and sexual risks and delivers a brief motivational risk-reduction intervention tailored to patients' readiness to change and risk profile. The brief motivational intervention includes personalized feedback, tailored advice messages, prompt sheets, peer modeling, and printed and multimedia information. The provider cueing sheet will summarize each patient's risks and suggest targeted risk-reduction messages to reinforce behavior change. The Positive Choice intervention can be seamlessly integrated into primary care for HIV-infected individuals. HIV-positive patients at two public hospital-based HIV-outpatient clinics who report substance abuse (alcohol and/or drug abuse) and/or unprotected sex will be enrolled in a randomized controlled trial. Patients in the intervention group will receive the brief motivational intervention and their providers will receive a cueing sheet at baseline and again at 6 months. We will determine whether the Positive Choice intervention increases rates of patient-provider discussions about risks, increases patients' acceptance of referral to substance abuse counseling, and reduces sexual risk behaviors at 6- and 12-month follow-up. If proven effective, Positive Choice could be implemented into other health care settings to improve the health of HIV-positive people and decrease the transmission of HIV.