Efficacy and Effectiveness of Multi-Behavior Interventions Relevant to HIV

艾滋病毒感染者的最佳健康结果通常取决于在多个层面上协调行为变化，包括坚持抗逆转录病毒治疗方案，减少酒精和药物使用，从事保护性性行为和药物相关行为，以及保持健康的运动，吸烟和饮食习惯。这些行为中的任何一种都代表着一种挑战，证据是发现行为干预在所有这些领域都有小到中等的影响。同时改变所有这些行为的挑战甚至更大，但革命性进步的潜力也是无与伦比的。我们认为，多行为干预的科学必须包括一个全面的理论基础，告知行为的组合，最大限度地提高行为，临床和经济成果，同时尽量减少医源性影响。该项目预计将产生一个全面的了解多种行为变化和技术来实现它，一个互动的网站，研究人员使用的数据，和决策树，以获得组合的建议，为不同的人群，促进者，地理区域，疾病流行情况和交付设置。该申请要求提供资金，通过考虑到某些行为组合或耦合比其他行为更有可能协同，来解码改变多种行为的最佳方法。考虑到在所有四个目标领域中组合行为的不可行性、时间和成本（例如，在一项随机对照试验中，我们建议对干预措施的行为和临床结果进行荟萃分析，这些干预措施涉及艾滋病毒相关行为、药物和酒精使用以及健康生活领域内和跨领域的至少两种健康行为。研究综合I将关注明确针对两种或两种以上行为的艾滋病毒特异性干预措施（例如，避孕套的使用、伴侣数量、药物依从性和性行为期间的药物使用）。研究综合II将考虑改变多种酒精/药物使用行为的干预措施（例如，酒精使用和坚持美沙酮治疗）。研究综合III将考虑改变多种健康生活方式行为的干预措施（例如，脂肪摄入、锻炼和吸烟）。《研究综述四》将在综述一至三所涉领域得出更广泛的结论。该项目将是艾滋病毒领域最雄心勃勃的荟萃分析，并将提供数据驱动和基于理论的相对功效和有效性估计，按不同性别、不同种族群体、不同大陆以及疾病流行率高低的地区分层。鉴于其广度，我们的项目将对预防和治疗艾滋病毒以及与我们的行为集群相关的许多其他疾病，包括癌症，心血管疾病和糖尿病等具有重要意义。此外，我们的项目将推进对早期和延迟行为变化的心理理解，以及解决复杂行为的行为干预设计。该项目的新奇源于一种变革性的理论，获得了以前不存在的数据，改进了统计方法，并以前所未有的方式将Meta分析和有效性研究配对。 公共卫生相关性：当当前的干预措施设计没有理解如何最佳地结合行为建议时，理论和基于证据的干预原则可能会催化转型。具体来说，研究这一惊人的未知领域有希望彻底改变艾滋病毒的行为治疗， 以及从癌症到心血管疾病到糖尿病的其他疾病。

DESCRIPTION (provided by applicant): Optimal health outcomes for people living with HIV often depend on orchestrating behavioral changes at many levels, including adhering to antiretroviral regimens, reducing alcohol and drug use, engaging in protective sex and drug-related behaviors, and keeping healthy exercise, smoking, and dietary habits. Any of these behaviors represents a challenge on its own, proof of which is the finding that behavioral interventions have small to moderate effects in all of these domains. The challenge of simultaneously changing all of these behaviors is even greater, but the potential for revolutionary advances is also unsurpassed. We argue that the science of multiple-behavior interventions must include a comprehensive rationale that informs the combinations of behaviors that maximize behavioral, clinical, and economic outcomes while minimizing iatrogenic effects. The project is expected to yield a comprehensive understanding of multiple behavior change and techniques to achieve it, an interactive website for researchers to use the data, and decision trees to derive combinatorial recommendations for different populations, facilitators, geographic areas, disease prevalence contexts, and delivery settings. This application requests funding to decode the best ways of changing multiple behaviors by taking into account that some behavior combinations or couplings are more likely to be synergistic than others. Given the unfeasibility, times, and costs of combining behaviors in all four target domains (e.g., over 20 behaviors) within a randomized controlled trial, we propose to meta-analyze the behavioral and clinical outcomes of interventions that address at least two health behaviors within and across the domains of HIV-related behaviors, drug and alcohol use, and healthy living. Research Synthesis I will concern HIV-specific interventions that explicitly address two or more behaviors (e.g., condom use, number of partners, medication adherence, and drug use during sex). Research Synthesis II will consider interventions to change multiple alcohol/drug use behaviors (e.g., alcohol use and adherence to methadone treatment). Research Synthesis III will consider interventions to change multiple healthy-lifestyle behaviors (e.g., fat intake, exercise, and smoking). Research Synthesis IV will reach broader conclusions across the domains addressed in Syntheses I-III. The project will be the most ambitious meta-analysis in the area of HIV, and will provide data-driven and theory-based estimates of comparative efficacy and effectiveness, stratified by different genders, different racial groups, different continents, and areas of high and low disease prevalence. Given its breadth, our project will be significant to the prevention and treatment of HIV as well as many other diseases related to our clusters of behaviors, including cancer, cardiovascular disease, and diabetes, among others. In addition, our project will advance the psychological understanding of early and delayed behavior change and the design of behavioral interventions addressing complex behaviors. The novelty of the project stems from a transformative theory, obtaining previously inexistent data, refined statistical methods, and pairing meta- analysis and effectiveness research in unprecedented ways. PUBLIC HEALTH RELEVANCE: When current interventions are designed without an understanding of how to optimally mesh behavior recommendations, a theory and evidence-based-intervention principles are likely to catalyze a transformation. Specifically, researching this strikingly uncharted territory has the promise to revolutionize behavioral treatment of HIV as well as other diseases from cancer to cardiovascular disease to diabetes.