Computer-based HIV Prevention for Seropositive Men

描述（由申请人提供）：自20世纪90年代末以来，新的艾滋病毒感染人数一直稳定在每年约50，000例新病例。初看起来，这10年来发病率的稳定似乎对艾滋病毒预防工作取得成功的观念提出了挑战。然而，在发病率稳定下来的同时，抗逆转录病毒药物也得到了广泛供应。通过让艾滋病毒感染者过上更长和更有生产力的生活，血清转化的机会增加了。尽管有这种可能性，但总体发病率并没有增加，某些传播方法（例如，注射毒品）的使用率显著下降。 然而，抗逆转录病毒药物的成功确实改变了预防工作的格局。虽然许多血清反应阳性的人在得知诊断后减少了他们的危险行为，但三分之一的性活跃者继续从事高风险的性活动。作为回应，疾病预防控制中心修订了其国家预防战略，倡导将重点放在那些被诊断患有艾滋病毒的人及其伴侣身上。尽管战略发生了这种转变，但在CDC“最佳证据”干预措施汇编中列出的41个预防项目中，只有7个侧重于二级预防。更令人不安的是，完成这些“最佳证据”干预措施之一所需的平均时间超过19小时的面对面时间。临床和社区环境没有人力资源来实施这种强化方案。此外，只有一项经经验验证的干预措施是专门为男子制定的。然而，最新的发病率数据显示，在美国所有新的艾滋病毒病例的75%的结果与感染man. To解决这一重大需求，我们打算开发一个原型预防计划，旨在减少艾滋病毒阳性男性（男男性行为者和MSW）的性传播相关的风险行为。该原型将以健康生活项目模块2和模块3的核心组成部分为基础。这些核心部分将辅之以预防教育，以应对男子在减少性风险方面面临的独特社会文化挑战。此外，拟议的干预措施将采取一个亲健康的重点，使它将被视为支持和非污名化。最后，它将以计算机为基础，以进一步提高病人和医生的接受程度，减少工作人员的时间，降低成本，提高治疗的准确性，并提高广泛传播的可能性。 第一阶段原型的开发也将由我们的专家顾问和典型最终用户的焦点小组提供信息，以确定他们的音频/视频偏好，预防需求和挑战，预防信念以及首选的信息传递模式。在此之后，将对原型进行基于任务的可用性测试，测试对象是在社区艾滋病毒/艾滋病服务提供者处寻求服务的男子。 公共卫生相关性：该项目旨在开发一种基于计算机的预防干预措施，旨在减少艾滋病毒阳性男子与性传播有关的风险行为。对于诊所来说，这将使它们能够向客户提供经经验验证的艾滋病毒预防干预措施，而不会对已经负担过重的工作人员提出额外的要求。对于男性来说，该计划所包含的技能将帮助他们减少危险行为，并最终防止艾滋病毒的传播。

DESCRIPTION (provided by applicant): Since the late 1990s, the number of new HIV infections has held steady at approximately 50,000 new cases each year. At first glance, this 10-year stability in incidence rate appears to challenge the notion that HIV prevention efforts have been successful. However, antiretrovirals (ARVs) also became widely availability at the same time incidence rates stabilized. By allowing those living with HIV to lead longer and more productive lives, the opportunity for seroconversion grows. Despite this potential, there has not been an increase in overall incidence, and certain methods of transmission (e.g., injection drug use) have seen significant drops. The success of ARVs did alter the prevention landscape, however. While many seropositive individuals reduce their risk behavior after learning of their diagnosis, one-third of those who are sexually active continue to engage in high risk sexual activities. In response, the CDC revised its national prevention strategy by advocating a focus on those who are diagnosed with HIV and their partners. Despite this shift in strategy, only 7 of the 41 prevention programs listed in the CDC compendium of "best evidence" interventions focus on secondary prevention. More troubling is that the average length of time required to complete one of these "best evidence" interventions is over 19 hours of face-to-face time. Clinical and community settings do not have the human resources to implement such intensive programs. Moreover, only one empirically validated intervention was developed specifically for men. Yet, the latest incidence data show that 75% of all new HIV cases in the United States results from sexual contact with an infected man. To address this significant need, we intend to develop a prototype prevention program designed to reduce sexual transmission-related risk behaviors for HIV-positive men (for both MSM and MSW). This prototype will be based on the core components of modules 2 and 3 of the Healthy Living Project (HLP). These core components will be supplemented with prevention education designed to address the unique sociocultural challenges men face in reducing their sexual risk. Additionally, the proposed intervention will adopt a pro- health focus so that it will be perceived as supportive and nonstigmatizing. Finally, it will be computer-based to further increase acceptability among patients and physicians, reduce staff time, lower costs, increase fidelity of treatment delivery, and enhance the probability of widespread dissemination. Development of the Phase I prototype will also be informed by our expert consultants and a focus group of typical end-users to determine their audio/visual preferences, prevention needs and challenges, prevention beliefs, and preferred mode of message delivery. Following this, the prototype will undergo task-based usability testing with men seeking services at community-based provider of HIV/AIDS services. PUBLIC HEALTH RELEVANCE: This project aims to develop a computer-based prevention intervention designed to reduce sexual transmission-related risk behaviors for HIV-positive men. For clinics, this will allow them to provide an empirically validated HIV prevention intervention to their clients without creating additional demands on their already overburdened staff. For men, the skills contained in this program will help them reduce risk behaviors and, ultimately, prevent the spread of HIV.