Web-facilitated intervention for heavy drinking and HIV risk

 描述(由申请人提供)：美国男男性行为者(MSM)中新感染艾滋病毒的年率继续快速增长，尽管其他群体保持稳定或下降。这一趋势突显了开发新工具以抗击艾滋病毒在男男性接触者中持续蔓延的持续重要性。虽然对男男性接触者存在一些降低性风险的干预措施，但重要的局限性限制了它们的影响。 这些障碍包括传播和/或实施的障碍，例如冗长的治疗方案，需要训练有素的干预者，以及仅限于医疗保健提供 设置。干预措施也未能解决导致高危行为的关键因素，特别是大量饮酒。测试干预措施的有效性以减少MSM酗酒的研究很少，而且大多只探索了跨越几周或几个月的更长的治疗方案。基于动机访谈(MI)原则的减少大量饮酒的单一暴露干预方法，通常被称为“个性化反馈干预”，已经开发出来，并在其他人群中成功地进行了测试。基于变化阶段和MI原则的类似的减少艾滋病毒风险的简短干预措施，如个性化认知咨询，也被证明在这些人中产生了有意义的减少无保护的性行为。这些平行的研究突显了开发一种简短的综合干预措施以减少MSM中的酒精使用和性行为风险的机会。通过基于技术或移动健康的形式调整和提供这些干预措施也将开始允许将干预措施扩展到传统互动和环境之外，潜在地提高有效性、灵活性和可扩展性。因此，拟议的研究将作为一个研究计划的基础，该计划的重点是开发技术辅助工具，这些工具可以轻松地提供给高危个人。这个为期三年的项目旨在开发和试点一种简短的联合干预措施，以减少男男性接触者中大量饮酒和无保护的性行为，并基于MI的原则。这种联合干预将适应基于平板电脑的格式，并专门为社区环境中的高危MSM使用而开发。这项研究包括两个阶段：第一阶段涉及进行定性研究，以(1)整合酒精使用和性风险干预的组成部分，(2)使其适应以技术为基础的形式，以及(3)了解和解决在实施、可行性和可接受性方面的挑战。第二阶段需要对寻求在社区环境中进行艾滋病毒检测的MSM进行随机对照试点试验，以探索其对酒精和艾滋病毒相关行为结果的潜在影响。这项研究最终将产生一种针对酗酒和性风险的综合、基于理论和技术的干预措施，该干预措施完全可携带，并已在高危男男性行为者参与预防服务的社区环境中进行了初步的有效性测试。

 DESCRIPTION (provided by applicant): Annual rates of new HIV infections among men who have sex with men (MSM) in the United States continue to grow rapidly, despite stability or decline among other groups. This trend highlights the ongoing importance of developing new tools to fight the continued expansion of the HIV epidemic among MSM. Although a number of sex risk reduction interventions exist for MSM, important limitations have restricted their impact. These include barriers to dissemination and/or implementation, such as lengthy treatment protocols, the need for highly- trained interventionists, and confining delivery only to healthcare settings. Interventions have also failed to address pivotal factors that lead to high-risk behavior specifically heavy drinking. Research testing the efficacy of interventions to reduce heavy drinking among MSM is scarce, and has mostly only explored lengthier treatment protocols that span several weeks or months. Single-exposure intervention approaches for reducing heavy drinking based on the principles of motivational interviewing (MI), commonly referred to as "Personalized Feedback Interventions," have been developed and tested in other populations with success. Similar brief interventions for HIV-risk reduction based on stages of change and MI-principles, such as Personalized Cognitive Counseling, have also been shown to produce meaningful reductions in unprotected sex among these individuals. These parallel lines of research highlight the opportunity for developing a brief, combined intervention for reducing both alcohol use and sex risk among MSM. Adapting and delivering these interventions via a technology-based or mHealth format would also begin to allow the extension of interventions beyond the traditional interactions and settings, potentially improving efficacy, flexibility, and scalability. As such, the proposed research will serve as the foundation for a research program focusing on developing technology-assisted tools that can be easily delivered to high-risk individuals. This three-year project aims to develop and pilot test a brief, combined intervention for reducing heavy drinking and unprotected sex among MSM based on principles of MI. This combined intervention will be adapted to a tablet- based format and developed specifically for use with high-risk MSM in community-based settings. The research involves two phases: Phase 1 involves conducting qualitative research to (1) integrate alcohol use and sex risk intervention components, (2) adapt them to a technology-based format, and (3) understand and address challenges in implementation, feasibility, and acceptability. Phase 2 entails conducting a randomized- controlled pilot test of the intervention among MSM seeking HIV testing in community-based settings to explore its potential impact on alcohol and HIV-related behavioral outcomes. This research will ultimately produce a combined, theory-based, and technology-delivered intervention for heavy drinking and sex risk that is fully portable and has been preliminarily tested for efficacy in community settings where high-risk MSM engage with prevention services.