PILOT INTERVENTION TO EMPOWER HIV CLIENTS AS PREVENTION ADVOCATES IN UGANDA

项目摘要 艾滋病毒/艾滋病患者在艾滋病毒预防方面可以发挥关键作用，而不仅仅是在 预防为阳性，治疗为预防，但作为艾滋病毒保护的有力变革因素 在其他行为中。我们的研究表明，随着PLHA接受艾滋病毒治疗并恢复健康 许多人都有保护亲人和从事预防宣传的动机(即 鼓励朋友和家人寻求艾滋病毒检测和治疗，并减少危险行为)；然而， 这一宣传的质量受到与信息内容、传递方式和时间安排有关的挑战的阻碍， 以及对倡导接受者的选择。通过有效的宣传培训，动员PLHA成为变革的推动者 在他们的社交网络中，有可能成为艾滋病毒预防的“游戏规则改变者”，特别是在高 流行环境，如乌干达，在那里，几乎每个家庭都会接触到艾滋病毒携带者。 借鉴基于网络的干预的理论框架，如社会扩散理论， 认知一致性和社会影响，这项拟议的研究将开发并试行“游戏规则改变者”-- 一种旨在赋予和动员PLHA成为艾滋病毒预防和行为代理人的干预措施 他们的社交网络的变化。在第一阶段，我们会分别举办小组讨论小组和小组成员 他们的社交网络(家人和朋友)，探索动员客户倡导的障碍和促进者 对于艾滋病毒预防，对宣传如何才能最有效地激励行为的看法发生了变化，以及 如何优化干预措施及其内容的结构。在阶段2中，我们将使用阶段1的调查结果，并绘制 从基于网络的干预模式发展干预的结构和内容，旨在 帮助客户克服耻辱，管理他们的疾病，积极生活，培养抗击艾滋病毒的动力和技能 披露和预防宣传。在第三阶段，我们将在96人的对照试验中试行团体干预 客户，其中48人随机分配接受干预，48人被分配到等待名单控制。评估将 在基线和4个月、8个月和12个月对所有参与者进行管理，之后对照组将 接受干预。调查和社交网络评估将检查干预对 参与者的防护行为(使用避孕套、坚持艾滋病毒治疗)和预防传播 网络中的消息，根据与网络的通信内容和程度进行评估 成员关于防护行为(避孕套使用、伴侣并发/伴侣数量、艾滋病毒检测、 参与艾滋病毒护理、包皮环切)、艾滋病毒披露和艾滋病毒污名。游戏改变者是创新的，因为它 涵盖所有主要艾滋病毒预防范例的方面，针对所有网络成员进行宣传，而不是 它不仅使用社交网络数据来评估影响，还使用社交网络数据 战略性地以宣传为目标。研究结果将为更大规模的R01试验提供参考。

Project Summary People living with HIV/AIDS (PLHA) have a critical role to play in HIV prevention, not only in the context of Prevention for Positives and Treatment as Prevention, but as powerful change agents for HIV protective behaviors among others. Our research suggests that as PLHA receive HIV treatment and restore their health and functioning, many are motivated to protect their loved ones and engage in prevention advocacy (i.e., to encourage friends and family to seek HIV testing and treatment, and to reduce risk behavior); however, the quality of this advocacy is hampered by challenges related to message content, style and timing of delivery, and selection of advocacy recipients. With effective advocacy training, mobilizing PLHA to be change agents within their social networks has the potential to be a “game changer” for HIV prevention, particularly in high prevalence settings such as Uganda, where virtually every family is touched by someone living with HIV. Drawing upon theoretical frameworks for network-based interventions, such as theories of social diffusion, cognitive consistency, and social influence, the proposed study will develop and pilot test “Game Changers”-- an intervention that aims to empower and mobilize PLHA to be agents for HIV prevention and behavioral change in their social networks. In Phase 1, we will conduct separate focus groups of PLHA and members of their social networks (family and friends) to explore barriers to and facilitators of mobilizing clients to advocate for HIV prevention, perceptions on how advocacy can be most effective in motivating behavior change, and how to best structure the intervention and its content. In Phase 2 we will use findings from Phase 1, and draw from network-based intervention models to develop the structure and content of an intervention designed to help clients cope with stigma, manage their disease, live positively, and develop motivation and skills for HIV disclosure and prevention advocacy. In Phase 3 we will pilot the group intervention in a controlled trial of 96 clients, with 48 randomly assigned to receive the intervention and 48 to the wait-list control. Assessments will be administered to all participants at baseline and months 4, 8 and 12, after which the control group will receive the intervention. Surveys and social network assessments will examine intervention effects on protective behaviors of the participant (condom use, HIV treatment adherence), and diffusion of prevention messages across the network, as assessed by the content and extent of communication with network members about protective behaviors (condom use, partner concurrency/number of partners, HIV testing, engagement in HIV care, circumcision), HIV disclosure, and HIV stigma. Game Changers is innovative as it encompasses aspects of all major HIV prevention paradigms, targets advocacy to all network members rather than within and by specific risk groups, and uses social network data not only to evaluate effects but also strategically target advocacy. Findings will inform a larger R01 trial.