Integrating HIV Prevention into Clinical Care for PLWHA in South Africa

说明(由申请者提供)：项目摘要：南非艾滋病毒流行病继续在社会各阶层造成灾难性的人类痛苦。然而，随着抗逆转录病毒疗法的推出，更多的南非人正在接受艾滋病毒检测，更多的人正在进入艾滋病毒临床护理。拟议的研究涉及开发、实施和评估文化上适当的艾滋病毒预防干预措施，该干预措施位于南非艾滋病毒临床护理的背景下，旨在协助南非PLWHA减少艾滋病毒传播风险行为。这种干预方法基于OPTIONS项目的行为改变框架；这是一种可接受的、可行的、有效的艾滋病毒预防干预措施，在美国艾滋病毒护理环境中实施，显著减少了艾滋病毒+个人的艾滋病毒传播风险行为。拟议研究的总体目标是创建一种文化上适当、有效和高效的干预战略，该战略可以在南非临床护理背景下广泛传播，以帮助遏制南非艾滋病毒的流行。拟议的研究设计涉及一项整群随机对照试验，比较在南非临床护理背景下提供的顾问驱动的艾滋病毒预防干预措施与标准护理对照措施在降低南非PLWHA中艾滋病毒传播风险行为和事件STI发生率方面的有效性。拟议调查的具体目的是与南非艾滋病防治机构和南非艾滋病毒护理人员一起进行形成性研究，找出南非艾滋病预防行为的独特障碍，并确定以可行和文化上可接受的临床护理为基础的干预措施克服这些障碍的方法；设计、试点测试、改进、实施和评估将在南非艾滋病毒护理环境中实施的干预措施，以协助南非艾滋病防治机构减少艾滋病毒传播风险行为和事件性传播感染；并利用护理控制标准作为队列，对艾滋病毒传播风险行为、性传播感染发生率以及与抗逆转录病毒治疗相关的健康改善如何与南非PLWHA中艾滋病毒风险行为的变化相关的自然历史进行纵向研究。关联性。拟议的研究旨在制定有效和易于传播的干预措施，在南非艾滋病毒流行的背景下，通过防止艾滋病毒传播给未受感染的个人和艾滋病毒+者获得性传播感染来改善个人和公共健康。

DESCRIPTION (provided by applicant): Project Summary: The South African HIV epidemic continues to cause catastrophic human suffering across all sectors of society. With the rollout of antiretroviral therapy, however, far more South Africans are being tested for HIV and far more are entering HIV clinical care. The proposed research involves development, implementation, and evaluation of a culturally-appropriate HIV prevention intervention, situated in the South African HIV clinical care context, and aimed at assisting South African PLWHA to reduce HIV transmission risk behavior. This intervention approach is based on the behavior change framework from the Options Project; an acceptable, feasible, and effective HIV prevention intervention, implemented in US HIV care settings, which significantly reduced HIV+ individuals' HIV transmission risk behavior. The overall objective of the proposed research is to create a culturally-appropriate, effective, and efficient intervention strategy that may be widely disseminated within the South African clinical care context, to aid in stemming the South African HIV epidemic. The proposed research design involves a cluster randomized controlled trial of the effectiveness of a counselor-driven HIV prevention intervention, delivered in the South African clinical care context, compared to a standard-of-care control, in reducing HIV transmission risk behavior and incident STI rates among South African PLWHA. Specific aims of the proposed investigation are to conduct formative research with South African PLWHA and South African HIV care personnel, to identify unique obstacles to HIV preventive behavior for South African PLWHA, and to identify ways of overcoming these obstacles, in a feasible and culturally-acceptable, clinical care-based intervention; to design, pilot test, refine, implement, and evaluate an intervention, to be delivered in the South African HIV care setting, to assist South African PLWHA to reduce HIV transmission risk behaviors and incident STI; and to utilize the standard of care control as a cohort for a longitudinal natural history study of HIV transmission risk behavior, STI incidence, and how health improvements associated with ARV treatment may be related to changes in HIV risk behavior among South African PLWHA. Relevance. The proposed research aims to develop an effective and readily disseminated intervention to improve individual and public health by preventing transmission of HIV to uninfected individuals, and acquisition of STI by HIV+ persons, in the context of the South African HIV epidemic.