Telehealth Assessment of Risk Behaviors in Rural HIV+ Substance Users

描述(申请人提供)：艾滋病毒感染模式已转向农村少数群体，但对相关风险因素和行为模式知之甚少，包括药物使用，这对于制定对人口敏感的具体干预措施至关重要。对危险行为的合理测量是这一倡议的基础，这项为期两年的R21应用程序建议调整和评估创新的基于电话的交互式语音应答(IVR)自我监控系统的效用，以供贫困的农村艾滋病毒+药物使用者使用。拟议的测量发展研究是由行为经济学指导的，行为经济学关注不同时间框架内的选择模式。这项研究是重要的第一步，将支持对农村艾滋病毒+药物使用者及其社会网络中的风险因素和模式的研究，并将指导旨在减少风险的干预措施的发展，包括远程保健服务。远程保健服务在扩大农村地区与卫生相关的干预措施的覆盖范围和有效性方面具有很大潜力。在完成程序的试点研究之后，参与者(N=50)将从阿拉巴马州一家乡村艾滋病毒医疗诊所的艾滋病毒阳性患者中招募，这些患者报告在过去90天内使用毒品或酒精以及与伴侣发生性行为。在评估和培训之后，参与者将使用IVR系统对他们的药物使用、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进行为期10周的自我监测。在第5周和第10周结束时，将进行结构化的可靠性访谈，通过与同一实时期间报告的关键IVR变量进行比较来评估数据质量。在开始自我监测之前，还将评估某些变量的数据质量，这些变量可以与医疗记录(例如，医疗访问)进行比较，并与药物使用和性行为的摘要措施进行比较。IVR系统的成功调整将允许收集支持风险模式详细分析的预期时间序列数据，包括涉及药物使用、危险的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系统还可以用于患者状态的长期远程动态监测，并可以支持精确定向的风险降低干预措施，这些干预措施可以个性化定制。

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.