Experimental Analysis of HIV Risk Assessment Reactivity in South African Clinics

描述（由申请人提供）：根据项目公告05-090“行为科学的方法论和测量”提交的修订申请，提出了行为评估反应性的实验分析，同时为南非性传播疾病（STD）诊所患者提供了一种有希望的艾滋病毒预防干预措施的额外功效数据。我们的主要目的是在南非开普敦的性病门诊患者样本中研究艾滋病毒风险行为评估对艾滋病毒风险行为和艾滋病毒预防干预结果的公共卫生影响和机制，南非开普敦是一个受艾滋病毒和艾滋病毒相关污名严重影响的地区。1500名患者（50%）女性将被随机分配到所罗门四组实验设计的延伸中。加上另一种基线评估，实验采用2（降低艾滋病毒风险干预：加强与标准护理咨询）x 3（基线行为访谈：无、一般与详细）析因设计。这两种实验基线行为访谈类似于目前主要的艾滋病预防试验中使用的访谈，不同之处在于它们要求参与者关注特定的危险行为实例。我们预期详细访谈将比一般访谈带来更多的评估反应性，并且单独的详细访谈将导致风险行为的减少。我们还将测试基于自我意识理论变体的假设，关于调解和调节评估反应性的机制。这项研究的结果将与预防科学领域以及南非的艾滋病毒预防有关。这项研究将首次通过实验将基线评估的影响与有效促进安全性行为的艾滋病毒预防干预的影响区分开来。这项研究也将是健康领域第一个探索认知和人际过程的研究，通过这些过程，评估反应发生，以及在自我报告风险行为后，调节行为改变的因素。关于公共卫生效益，这些结果将有助于确定如何最大限度地发挥向社区组织传播的预防干预措施的效果，并可能有助于制定利用评估反应的简短、增强动机的减少艾滋病毒风险干预措施。结果也将与杀微生物剂试验相关，这些试验经常使用重复的详细行为评估，这可能会改变参与者使用杀微生物剂的意愿并扭曲结果。

DESCRIPTION (provided by applicant): This revised application, submitted in response to Program Announcement 05-090 "Methodology and Measurement in the Behavioral Sciences," proposes an experimental analysis of behavioral assessment reactivity, while generating additional efficacy data on a promising HIV prevention intervention for South African sexually transmitted disease (STD) clinic patients. Our primary aim is to examine the public health impact and mechanisms underlying the effects of HIV risk behavior assessment on HIV risk behavior and on HIV prevention intervention outcomes in a sample of STD clinic patients in Cape Town, South Africa, an area severely affected by HIV and HIV-related stigma. 1500 patients (50%) women will be randomly assigned to condition in a extension of the Solomon Four Group experimental design. With an additional type of baseline assessment, the experiment is a 2 (HIV risk reduction intervention: enhanced vs. standard of care counseling) x 3 (baseline behavioral interview: none vs. general vs. detailed) factorial design. The two experimental baseline behavioral interviews are analogous to those currently used in major HIV prevention trials, and differ in the amount they require participants to focus on specific instances of risk behavior. We expect that the detailed interview will lead to more assessment reactivity than the general interview and that the detailed interview alone will lead to reductions in risk behavior. We will also test hypotheses based on variants of self-awareness theory regarding the mechanisms that mediate and moderate assessment reactivity. Results of this study will be relevant to the field of prevention science as well as to HIV prevention in South Africa. This study will be the first to experimentally disentangle the influence of baseline assessments from that of an HIV prevention intervention effective at promoting safer sexual behaviors. The study will also be the first in the health domain to explore the cognitive and interpersonal processes by which assessment reactivity occurs and the factors that moderate behavior change following self-reports of risk behavior. Regarding public health benefits, these results will help to determine how to maximize the effects of prevention interventions disseminated to community based organizations, and may help to develop brief, motivation-enhancing HIV risk-reduction interventions that capitalize on assessment reactivity. Results will also be relevant to microbicide trials that often use repeated detailed behavioral assessments, which may alter participants' willingness to use the microbicide and distort the outcomes.