Individually Tailored Computerized HIV Intervention

描述(申请人提供)：本申请是对PA 95-070“预防艾滋病传播的简要干预措施”的回应，旨在为一项为期五年的项目寻求资金，该项目旨在评估在感染艾滋病毒的高风险人群中实施交互式、个性化和基于计算机的减少艾滋病毒风险干预措施的效果。由于预算危机影响到公共卫生诊所的资源，需要制定提供初级艾滋病毒预防干预措施的高效、成本效益高的方法。目前的技术允许将行为科学原理整合到简短且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，与标准的全程面对面减少风险咨询相比，这种类型的干预与简短的面对面咨询相结合，可以以更低的成本产生更好的减少风险效果。为了测试这一想法，我们将使用形成性研究和理论来开发一种互动的、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，可供具有各种计算机经验的人使用。计算机软件将使用每个参与者的回答来提供详细的、个性化的反馈，并将帮助客户制定降低风险的计划。所有信息将显示在计算机上，更详细的信息将作为个性化的带回家的风险降低指南打印出来。我们将招募600名在市中心公共STI诊所进行常规护理的高危参与者(50%为女性)，并随机将参与者分配到三种干预条件之一：基于疾控中心以客户为中心的咨询模式(护理标准)进行30分钟的艾滋病毒风险降低咨询；30分钟的计算机干预；或同样的30分钟的计算机干预，然后使用参与者的问题和打印的降低风险指南作为刺激进行10分钟的补充咨询。我们将评估参与者的HIV风险行为和决定因素，源自HIV预防行为的信息-动机-行为技能模型，在基线和1、3、6和12个月的随访中，使用计算机化的评估来减少报告偏差。我们假设，与全程标准咨询或单独的计算机干预相比，计算机化咨询与简短的补充咨询相结合将导致更大的性风险降低。我们还将评估干预措施的成本效益，并预计联合干预措施将比标准咨询更具成本效益。在STI诊所和其他艾滋病毒检测地点开发有效的降低艾滋病毒风险的计算机化干预措施，并辅之以简短的咨询，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的高危人群-但需要的资源比标准咨询更少。

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.