Individually Tailored Computerized HIV Intervention

描述（由申请人提供）：本申请是对PA 95-070“预防艾滋病传播的简短干预措施”的回应，旨在为一个为期五年的项目提供资金，以评估一种互动式、个性化和基于计算机的艾滋病毒风险降低干预措施在感染艾滋病毒高危人群中的有效性。由于预算危机对公共卫生诊所的资源造成冲击，需要制定有效的、具有成本效益的方法来提供艾滋病毒初级预防干预措施。目前的技术允许将行为科学原则整合到简短和引人入胜的计算机提供的艾滋病毒风险降低干预措施中。我们认为，这种类型的干预，结合简短的面对面咨询，可以产生更好的降低风险的效果，降低成本时，与标准相比，全长面对面的风险降低咨询。为了验证这一想法，我们将使用形成性研究和理论来开发一种交互式的、计算机化的、多媒体的、个性化的艾滋病毒风险降低干预措施，这种干预措施可由具有各种计算机经验的人使用。计算机软件将利用每个参与者的答复提供详细的、针对个人的反馈，并将协助客户制定减少风险的计划。所有信息都将在计算机上显示，更详细的信息将作为个性化的减少风险指南打印出来。我们将招募600名高危参与者（50%的女性）在市中心的一家公共性病诊所接受常规护理，并将参与者随机分配到三种干预条件之一：基于CDC以客户为中心的咨询模式进行30分钟的艾滋病毒风险降低咨询（标准护理）; 30分钟基于计算机的干预;或者同样的30分钟的电脑干预，然后是10分钟的补充咨询，使用参与者的问题和印刷的风险降低指南作为刺激。我们将评估参与者的艾滋病毒风险行为和决定因素，来自基线时的艾滋病毒预防行为的信息-动机-行为技能模型，并在1个月，3个月，6个月和12个月的随访中，使用计算机评估以减少报告偏倚。我们假设，计算机化咨询结合简短的补充咨询将导致更大的性风险降低比全长标准咨询或单独的计算机化干预。我们还将评估干预措施的成本效益，并预计综合干预措施将比标准咨询更具成本效益。在性传播感染诊所和其他艾滋病毒检测点开发有效的计算机化干预措施以降低艾滋病毒风险，并辅以简化的咨询，可能会产生一种有效的艾滋病毒预防干预措施，这种干预措施在现实世界中是可行的，可以用于许多艾滋病毒感染高风险的人，但比标准咨询需要更少的资源来实施。

DESCRIPTION (provided by applicant): This application, in response to PA 95-070 "Brief Interventions to Prevent the Spread of AIDS," seeks funding for a five-year project to evaluate the efficacy of an interactive, individually tailored and computer-based HIV risk reduction intervention among people at high risk for contracting HIV. Efficient cost-effective methods for delivering primary HIV prevention interventions need to be developed, as budget crises impinge upon resources in public health clinic settings. Current technology allows behavioral science principles to be integrated into brief and engaging computer-delivered HIV risk reduction interventions. We believe that this type of intervention, in conjunction with abbreviated face-to-face counseling, can produce improved risk reduction effects at reduced cost when compared with standard, full-length face-to- face risk reduction counseling. To test this idea, we will use formative research and theory to develop an interactive, computerized, multimedia, individually tailored HIV risk-reduction intervention usable by people with all levels of computer experience. The computer software will use each participant's responses to provide detailed, individually tailored feedback and will assist the client in developing a risk reduction plan. All information will be presented on the computer and more detailed information will be printed as a personalized take-home risk reduction guide. We will recruit and enroll 600 at-risk participants (50% women) presenting for routine care at an inner-city public STI clinic and randomly assign participants to one of three intervention conditions: A 30-minute session of HIV risk reduction counseling based on the CDC client-centered counseling model (standard of care); the 30-minute computer-based intervention; or the same 30-minute computer intervention followed by 10 minutes of supplemental counseling, using the participant's questions and printed risk-reduction guide as stimuli. We will assess participants' HIV risk behavior and determinants, derived from the Information-Motivation-Behavioral Skills model of HIV preventive behavior at baseline, and at 1, 3, 6, and 12 month follow ups, using computerized assessments to reduce reporting biases. We hypothesize that the computerized counseling combined with abbreviated, supplemental counseling will result in greater sexual risk reduction than full-length standard counseling or the computerized intervention alone. We will also evaluate the cost-effectiveness of the interventions and expect that the combined intervention will be more cost-effective than standard counseling. Developing effective computerized interventions for HIV risk reduction at STI clinics and other HIV testing sites and supplementing them with abbreviated counseling may result in an efficient HIV prevention intervention that is feasible in real-world settings, and which can be used with many people at high risk for HIV infection - but which requires fewer resources to implement than standard counseling.