Telehealth Assessment of Risk Behaviors in Rural HIV+ Substance Users

描述（由申请人提供）：艾滋病毒感染模式已转向农村少数民族，但对相关风险因素和行为模式知之甚少，包括物质使用，这对于制定人口敏感和具体的干预措施至关重要。风险行为的健全测量是这项倡议的基础，这项为期2年的R21申请建议调整和评估创新的基于电话的交互式语音应答（IVR）自我监测系统的效用，用于贫困的农村艾滋病毒+药物使用者。拟议的测量发展研究是由行为经济学，这是在不同的时间范围内的选择模式。这项研究是重要的第一步，将支持对农村艾滋病毒阳性药物使用者及其社交网络的风险因素和模式的研究，并将指导制定旨在减少风险的干预措施，包括远程保健服务。远程保健服务在扩大农村地区保健干预措施的覆盖面和有效性方面具有很大潜力。在试点研究完成程序后，将从亚拉巴马农村HIV医疗诊所的HIV+患者中招募参与者（N = 50），这些患者报告在过去90天内使用药物或酒精以及涉及伴侣的性活动。经过评估和培训后，参与者将使用IVR系统自我监测他们的物质使用，性行为以及与艾滋病毒风险暴露机会相关的社会和经济变量，为期10周。将在第5周和第10周结束时进行结构化可靠性访谈，以通过与相同真实的时间段内报告的关键IVR变量进行比较来评估数据质量。还将评估数据质量，以选择适合与医疗记录进行比较的变量（例如，医疗护理访视），并在开始自我监测之前对药物使用和性行为进行汇总测量。IVR系统的成功适应将允许收集支持风险模式的详细分析的前瞻性时间序列数据，包括涉及物质使用、危险性行为以及社会和经济背景变量的纵向序列。除了为行为研究提供高质量的测量工具外，IVR系统还可用于对患者状态进行长期远程动态监测，并可支持精确针对性的风险降低干预措施。

DESCRIPTION (provided by applicant): HIV infection patterns have shifted toward rural minorities, but little is known about relevant risk factors and behavior patterns, including substance use, which is essential for developing population sensitive and specific interventions. Sound measurement of risk behaviors is fundamental to this initiative, and this 2-year R21 application proposes to adapt and evaluate the utility of an innovative telephone-based Interactive Voice Response (IVR) self-monitoring system for use with poor rural HIV+ substance users. The proposed measurement development study is guided by behavioral economics, which is concerned with patterns of choice over different timeframes. The study is an important first step that will support research on risk factors and patterns among rural HIV+ substance users and their social networks and will guide the development of interventions aimed at risk reduction, including telehealth services. Telehealth services have much potential to extend the reach and effectiveness of health-related interventions in rural areas. Following a pilot study to finalize procedures, participants (N = 50) will be recruited from HIV+ patients at a rural Alabama HIV medical clinic who report drug or alcohol use and sexual activity involving a partner during the past 90 days. After assessment and training, participants will self-monitor their substance use, sexual practices, and social and economic variables relevant to HIV-risk exposure opportunities for 10 weeks using the IVR system. Structured reliability interviews will be conducted at the end of Weeks 5 and 10 to assess data quality through comparisons with key IVR variables reported during the same real time periods. Data quality also will be assessed for select variables amenable to comparisons with medical records (e.g., medical care visits) and with summary measures of substance use and sexual practices prior to the start of self-monitoring. Successful adapation of the IVR system will allow collection of prospective time series data that support detailed analysis of risk patterns, including longitudinal sequences involving substance use, risky sexual practices, and social and economic contextual variables. In addition to providing a high quality measurement tool for behavioral research, the IVR system can be used for long-term remote ambulatory monitoring of patient status and can support precisely targeted risk reduction interventions that can be individually tailored.