Behavioral Intervention to Enhance HIV Test/Treat

描述（由申请人提供）：旨在检测和治疗艾滋病毒感染者的预防战略受到艾滋病毒治疗不依从性和性传播合并感染（STI）的破坏。迫切需要可扩展的干预措施，通过改善艾滋病毒治疗依从性和降低艾滋病毒传播风险来维持低传染性。本申请旨在测试一种基于理论的行为干预，以同时改善使用酒精和其他药物的艾滋病毒/艾滋病感染者的艾滋病毒治疗依从性并减少艾滋病毒传播风险行为。以决策冲突理论为基础，干预将以混合形式提供，其中一次以办公室为基础的咨询会议，随后是四次通过手机提供的咨询会议。干预将在亚特兰大及周边贫困地区进行。将从艾滋病服务机构和传染病诊所招募接受艾滋病毒治疗的男性（n = 250）和女性（n = 250）。在知情同意和基线评估之后，参与者将被随机分配到(a)综合艾滋病毒治疗依从性-降低风险干预或(b)时间匹配的非污染注意力控制条件。参与者将被跟踪12个月，使用基于办公室的计算机访谈，不事先通知的药片计数和医疗图表提取。该研究将验证一个假设，即基于理论的统一、综合的HIV治疗和降低风险干预将减少HIV传播风险行为，提高HIV治疗依从性，降低病毒载量并预防新的STI。本研究亦将探讨理论建构与结构障碍对干预结果的影响。在12个月的随访期间，预测不依从性复发和与病毒载量和性传播感染变化相关的风险行为的因素也将是研究的重点。正在调查的干预措施将是第一批同时解决治疗依从性和风险行为的综合模型，用于使用药物的艾滋病毒阳性男性和女性。如果证明有效，干预模式将准备立即推广到社区和临床服务，为艾滋病毒/艾滋病感染者提供服务。

DESCRIPTION (provided by applicant): Prevention strategies that aim to test and treat people for HIV infection are undermined by HIV treatment non-adherence and sexually transmitted co-infections (STI). Scalable interventions are urgently needed to sustain low infectiousness by improving HIV treatment adherence and reducing risks for transmitting HIV. This application proposes to test a theory-based behavioral intervention to simultaneously improve HIV treatment adherence and reduce HIV transmission risk behaviors in people living with HIV/AIDS who use alcohol and other drugs. Grounded in Conflict Theory of Decision Making, the intervention will be delivered in a mixed format, with one office-based counseling session followed by four cell phone delivered counseling sessions. The intervention will be conducted in Atlanta and surrounding impoverished areas. Men (n = 250) and women (n = 250) receiving HIV treatment will be recruited from AIDS services and infectious disease clinics. Following informed consent and baseline assessments, participants will be randomly assigned to either an (a) integrated HIV treatment adherence - risk reduction intervention or (b) a time-matched non-contaminating attention control condition. Participants will be followed for 12-months using office-based computerized interviews, unannounced pill counts, and medical chart abstraction. The study will test the hypothesis that a unified, integrated theory-based HIV treatment and risk reduction intervention will reduce HIV transmission risk behaviors, improve HIV treatment adherence, reduce viral load and prevent new STI. The study will also examine the influence of theoretical constructs and structural barriers on intervention outcomes. Factors that predict relapse to non-adherence and risk behaviors in relation to changes in viral load and STI over the 12-month follow-up period will also be a focal point of the study. The intervention under investigation will be among the first to simultaneously address treatment adherence and risk behavior in an integrated model for substance using HIV positive men and women. If shown effective, the intervention model will be ready for immediate dissemination to community and clinical services for people living with HIV/AIDS. PUBLIC HEALTH RELEVANCE: Prevention strategies that aim to test and treat people for HIV infection are undermined by HIV treatment non-adherence and sexually transmitted co-infections (STI). The proposed study will test a theory-based behavioral intervention to reduce HIV infectiousness by simultaneously improving HIV treatment adherence and reducing sexually transmitted co-infections in people living with HIV-AIDS who use alcohol and other drugs. The intervention is delivered in a single office-based counseling session followed by 4 cell phone delivered counseling sessions in a model that will be ready for immediate dissemination to case management and clinical services for people living with HIV/AIDS in resource constrained settings.