Efficacy and Effectiveness of Multi-Behavior Interventions Relevant to HIV

描述（由申请人提供）：艾滋病毒感染者的最佳健康结果通常取决于在许多层面上协调行为改变，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本身都是一个挑战，证据是发现行为干预在所有这些领域都有轻微到中度的影响。同时改变所有这些行为的挑战更大，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，以最大限度地提高行为、临床和经济结果，同时最大限度地减少医源性影响。该项目预计将产生对多种行为改变和实现它的技术的全面理解，一个供研究人员使用数据的交互式网站，以及决策树，以获得针对不同人群、促进者、地理区域、疾病流行背景和交付环境的组合建议。该应用程序请求资金，通过考虑到一些行为组合或耦合比其他行为更有可能协同作用，来解码改变多种行为的最佳方法。考虑到在一项随机对照试验中将所有四个目标领域（例如，超过20种行为）的行为结合起来的不可行性、时间和成本，我们建议对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或跨领域的至少两种健康行为的干预措施的行为和临床结果进行meta分析。研究综合I将关注明确针对两种或两种以上行为（例如，避孕套的使用，性伴侣的数量，药物依从性和性行为中的药物使用）的艾滋病毒特定干预措施。综合研究II将考虑改变多种酒精/药物使用行为的干预措施（例如，酒精使用和美沙酮治疗的依从性）。综合研究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、运动和吸烟）。研究综合IV将在综合I-III中讨论的领域中得出更广泛的结论。该项目将是艾滋病毒领域最雄心勃勃的荟萃分析，并将根据不同性别、不同种族群体、不同大洲以及疾病流行高低地区，提供基于数据和理论的比较功效和有效性估计。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，我们的项目将促进对早期和延迟行为改变的心理学理解，以及针对复杂行为的行为干预设计。该项目的新颖性源于一种变革性的理论，获得以前不存在的数据，改进的统计方法，并以前所未有的方式配对元分析和有效性研究。

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.