Intervening with HIV+ Alcohol Abusers: Influence of Neuro-Behavioral Factors

描述（由申请人提供）：拟议的随机对照研究将试图减少艾滋病毒性传播风险和药物使用，增加初级艾滋病毒护理服务的利用率，并改善320名酗酒、艾滋病毒阳性个体的心理社会健康。实验性干预措施将包括调整整体健康恢复方案（HHRP； Margolin等人，2003年），这是唯一一项基于证据的艾滋病毒+干预措施，旨在改善成瘾人群的性风险和依从性结果。在这项研究中，干预措施将适用于文化多样化的酗酒样本。HHRP将与健康促进比较（HPC）条件进行比较，后者处理常见的健康问题，包括个人卫生和健康生活。具体目的包括：1)比较HHRP与HPC状况，以评估HHRP是否能降低艾滋病毒性传播风险、酒精和其他药物的使用，并改善艾滋病毒初级保健服务和心理社会健康的利用；2)评估信息、动机、行为技能对安全性行为结果的干预效果；3)评估关键神经心理学和分子遗传因素如何调节干预对HIV传播风险结局的影响。招聘地点主要位于迈阿密人口密集、多文化、低收入的城市地区，这些地区的滥用不良药物、艾滋病毒、暴力和贫困率很高，绝大多数人口没有保险，存在多种健康差距。本研究采用前瞻性、随机双组队列设计。预定的程序顺序为：a)知情同意、筛查和基线评估；b)每周进行一次120分钟的HHRP或HPC组课程，连续12周；c)干预后评估。随访评估方案将在干预后3、6和12个月实施。还将进行分子/基因分型的神经心理学和血液测试，以协助确定可能影响干预研究效果的因素。

DESCRIPTION (provided by applicant): The proposed randomized controlled study will attempt to reduce HIV sexual transmission risk and substance use, increase the utilization of primary HIV care services, and improve psychosocial health among a sample of 320 alcohol abusing, HIV+ individuals. The experimental intervention will include an adaptation of the Holistic Health Recovery Program (HHRP; Margolin et al., 2003) that is the only evidence-based, HIV+ intervention for improving sexual risk and adherence outcomes for an addicted population. For this study, the intervention will be adapted for use in a culturally diverse, alcohol abusing sample. HHRP will be compared to a Health Promotion Comparison (HPC) condition, which addresses common health problems, including personal hygiene and healthy living. Specific aims include: 1) comparing the adapted HHRP to the HPC condition to evaluate if HHRP reduces HIV sexual transmission risk, alcohol and other drug use, and improves the utilization of primary HIV care services and psychosocial health; 2) evaluating how Information, Motivation, Behavioral Skills mediate intervention effects on safe sex outcome; and 3) evaluating how key neuropsychological and molecular-genetic factors moderate the effect of the intervention on HIV transmission risk outcomes. Recruitment sites are primarily located in densely populated, multicultural, low income, urban areas of Miami with high rates of AOD abuse, HIV, violence and poverty, with the vast majority of the population being uninsured and suffering from multiple health disparities. The study is a prospective, randomized by cohort two-group design. The scheduled sequence of procedures will be: a) informed consent, screening, and baseline assessment; b) a 120 minute group session of HHRP or HPC sessions administered once a week for 12 consecutive weeks; and c) a post- intervention assessment. Follow-up assessment protocols will be administered at 3, 6, and 12 months post-intervention. Neuropsychological and blood tests for molecular/genetic typing will also be conducted to assist in identifying factors which may influence the impact of the intervention study. The proposed study will attempt to reduce HIV sexual transmission risk and substance use among a sample of alcohol abusing, HIV+ individuals. In studying the memory, information processing, executive functioning as well as genetic factors of the individuals of this study, researchers will be better able to discern those factors which may have an impact on treatment effects. This study therefore has the potential to identify individual characteristics that may contribute to specific reductions in risky behaviors in this sample.