Positive Choice: Prevention for Positive Health

描述（由申请人提供）：药物滥用和性危险行为会极大地危害艾滋病毒/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，在不增加卫生保健提供者负担的情况下最大限度地发挥其作用。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方面大有希望；向风险人群和治疗不足人群提供简短的激励性干预措施；并激活供应商提供预防信息。我们建议发展积极选择，包括多媒体程序，提供者和患者教育，以及提供者提示的干预。多媒体项目的特色是视频医生评估患者的药物使用和性风险，并根据患者的改变意愿和风险概况提供简短的动机性降低风险干预。简短的动机干预包括个性化反馈、量身定制的建议信息、提示表、同伴建模以及印刷和多媒体信息。提供者提示表将总结每个患者的风险，并建议有针对性的降低风险的信息，以加强行为改变。积极选择干预措施可以无缝地纳入艾滋病毒感染者的初级保健。在两家公立医院的艾滋病毒门诊诊所，报告滥用药物（酒精和/或药物滥用）和/或无保护的性行为的艾滋病毒阳性患者将被纳入一项随机对照试验。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单。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增加了患者与提供者关于风险的讨论率，增加了患者对药物滥用咨询的接受程度，并减少了性风险行为。如果被证明有效，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患者的健康并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.