Multi-level HIV Prevention for Pregnant Drug Abusers

描述（由申请人提供）：拟议的研究针对正在治疗的怀孕药物滥用者，是一项随机试验，将增强行为技能训练（E-BST）与时间和注意力匹配的健康促进比较（HPC）条件进行比较。E-BST是对原始BST干预的改进（Eldridge, St. Lawrence et al. 1997），旨在加强原始BST中基于关系的社会能力技能，这些技能对于维持保护行为的坚持至关重要。E-BST强调与性伴侣/重要他人的协商/沟通技巧以及寻求帮助和服务利用的社会生态技能。这种在多个互动层面上的生态增强——在最初的BST试验中指出，这有可能促进拒绝技能——可能在干预结束后继续加强行为改变。BST是妇女在药物治疗中唯一有效的行为干预措施之一；然而，只显示出有限的短期收益。越来越多的证据表明，除非干预措施超越个人，解决能够在实际生活中赋予妇女权力的环境因素，并解决采取和维持保护行为的困难，否则影响将继续很小。参与者将是320名不同文化背景（30%西班牙裔，60%非洲裔）的怀孕药物滥用者，随机分配到E-BST和HPC组。我们将使用HIM来探讨干预效果是如何被理论相关的个体认知行为因素（如信息-动机-行为；Fisher and Fisher, 1992）和情境因素（如药物滥用、服务和社会支持利用）介导的，并被关键背景因素（认知功能和创伤性虐待史）调节的。拟议的项目回应了NIH对转化研究的优先考虑，以使有效的基于研究的干预策略适应“现实世界”的条件。如果成功，这项研究将提供一种可实现的艾滋病毒干预策略，将研究与实践联系起来，可以在其社区内对怀孕的药物滥用者实施。

DESCRIPTION (provided by applicant): The proposed study, targeting Pregnant Drug Abusers in treatment, is a randomized trial of Enhanced- Behavioral Skills Training (E-BST) compared to a time- and attention-matched Health Promotion Comparison (HPC) condition. E-BST is an adaptation of the original BST intervention (Eldridge, St. Lawrence et al. 1997), designed to strengthen relationship-based social competency skills of the original BST were crucial in sustaining adherence to protective behavior. The E-BST emphasizes negotiation/communication skills with sexual partners/significant others and social ecological skills of help- seeking and service utilization. Such ecological enhancements at multiple interactive levels-pointed to in the original BST trial as potentially facilitative of refusal skills-may provide continued reinforcement of behavioral change even after the intervention has ended. BST is one of the only effective behavioral interventions for women in drug treatment; however, only modest, short-term gains were demonstrated. Growing evidence indicates that impacts will continue to be minimal until interventions go beyond the individual to address contextual factors that can empower women in their actual life situations and address the difficulty of adopting and sustaining protective behavior. Participants will be 320 culturally diverse (30% Hispanic, 60% African American) pregnant drug abusers in treatment with random assignment to the E-BST and HPC. We will use HIM to explore how intervention effects are mediated by theoretically relevant Individual Cognitive-Behavioral (e.g., Information-Motivation-Behavior; Fisher and Fisher, 1992) and Contextual (e.g., Drug Abuse, Service and Social Support Utilization) factors and moderated by key background factors: cognitive functioning and traumatic abuse history. The proposed project responds to the NIH priority on translational research to adapt effective research-based intervention strategies to "real world" conditions. If successful, this research will offer a realizable HIV intervention strategy, bridging research and practice, that can be implemented for pregnant drug abusers within their communities.