A comprehensive approach to secondary HIV prevention and care among positives

描述（由申请人提供）：本申请是R 01 DA 032217 -01的修订版。随着美国艾滋病毒血清阳性人数的增加，需要增加二级预防和优化初级艾滋病毒医疗保健。由于许多血清阳性者不知道自己的血清状况，因此还需要增加接触高危个体的VCT方案。我们以前的社会网络为导向的干预措施已经证明，降低风险的扩散和招募血清反应阳性注射吸毒者（IDUs）的能力。鉴于注射吸毒者中艾滋病毒的性传播率很高，艾滋病毒的耐药性很高，以及注射吸毒的慢性性质，需要采取有效的行为干预战略，解决注射吸毒者及其风险网络成员中的风险行为，并使之能够持续下去。还迫切需要制定方案，让易受感染的吸毒者/艾滋病毒感染者/艾滋病患者（PLHA）参与并保留在艾滋病毒初级医疗保健中。参与艾滋病毒初级保健已被发现预测病毒学和临床结果。与其他艾滋病毒种族或暴露群体相比，对艾滋病毒初级保健的参与程度低且不一致，导致非裔美国人和注射吸毒者的艾滋病毒发病率和死亡率较高。拟议研究的主要目标是建立在我们先前干预措施的基础上，将IDU PHLA培训为同伴健康教育者，将（1）招募高风险网络成员进行VCT，（2）促进网络风险降低，（3）通过鼓励其HIV血清阳性网络成员安排和保持HIV初级保健预约，现实的患者-提供者角色期望，和讨论艾滋病医疗的社会规范。我们建议招募和随机分配一半的300注射吸毒者PLHA（称为指数），主要是非洲裔美国人，实验同伴健康教育培训和一半的注意力控制条件。在这两种情况下，将鼓励参与者招募高风险网络成员进行VCT。我们预计将有270个网络注册。为了提高干预效果的可持续性，将为实验参与者及其网络成员提供艾滋病毒护理支持课程。我们预计，同伴健康教育者的作用将被视为有意义的注射吸毒者，谁有最小的机会，亲社会的角色，社会奖励将有助于维持同伴健康教育和社会传播的干预效果。而且这 这种方法可以为PLHA提供目标设定、解决问题和沟通技巧方面的培训，这些培训可以应用于个人和专业情况。

DESCRIPTION (provided by applicant): This application is a revision to R01DA032217-01. With the growing number of HIV seropositives in the US, there is a need for increasing secondary prevention and optimizing primary HIV medical care. As many seropositives are unaware of their serostatus there is also a need for increased VCT programs that reach high risk individuals. Our prior social network oriented interventions have demonstrated diffusion of risk reduction and the ability to recruit seropositive injection drug users (IDUs). Given the substantial rates of sexual HIV transmission and high levels of drug resistant HIV among IDUs, as well as the chronic nature of injection drug use, there is a need for effective behavioral intervention strategies that address risk behaviors among IDUs and their risk network members that can be sustained.. There is also an urgent need to develop programs to engage and retain vulnerable drug using people living with HIV/AIDS (PLHAs) in primary HIV medical care. Engagement in HIV primary care has been found to predict virologic and clinical outcomes. Low and inconsistent engagement in HIV primary care contributes to African Americans' and IDUs' higher HIV morbidity and mortality rates compared to other HIV racial or exposure groups. The main goal of the proposed study, which builds on our prior interventions is to train IDU PHLAs to be peer health educators will (1) recruit high risk network members for VCT, (2) promote network risk reduction, and (3) promote engagement in HIV care and treatment by encouraging their HIV seropositive network members to schedule and keep HIV primary care appointments, realistic patient-provider role expectations, and social norms of discussing HIV medical care. We propose recruiting and randomly assigning half of 300 IDUs PLHAs (termed indexes), predominantly African American, to an experimental peer health educator training and half to an attention control condition. Participants in both conditions will be encouraged to recruit high ris network members for VCT. We anticipate 270 networks will enroll. To enhance sustainability of intervention effects, experimental participants and their network members will be offered support sessions on HIV care. We expect that the peer health educator role will be perceived as meaningful to IDUs, who have minimal opportunities for prosocial roles, and that social rewards will help sustain peer health education and social diffusion of intervention effects. Moreover this approach can provide PLHA with training in goal setting, problem solving, and communication skills that can be applied to personal and professional situations.