Prevention among HIV+ Crack Users in the Hospital

描述（由申请人提供）：艾滋病毒预防信息通常针对未感染的高危人群，重点是预防艾滋病毒的感染。最近，艾滋病毒预防领域的一个转变是认识到为艾滋病毒阳性者制定干预战略的重要性，因为每一个新的感染都是从已经感染艾滋病毒的人开始的。先前的研究表明，许多艾滋病毒阳性者继续从事不安全的风险行为，而快克的使用与这些风险行为密切相关。这些数据还表明，快克的使用与初级门诊艾滋病毒护理的使用呈负相关。医院或住院病房可能是一个重要的，但在很大程度上尚未开发的设置，以提供预防干预措施，高风险，艾滋病毒阳性的裂缝用户。医院也为感染快克使用者的艾滋病毒预防干预提供了一个重要的环境，因为住院治疗可以作为一个“可教的时刻”，当患者对行为改变干预持开放态度时。 我们在迈阿密大学和埃默里大学之间进行的多中心研究将在佛罗里达迈阿密的杰克逊纪念医院和格鲁吉亚亚特兰大的格雷迪纪念医院进行。我们将评估一个简短的，理论指导的，“预防保健倡导者”干预与艾滋病毒阳性裂纹用户从艾滋病毒住院病房在杰克逊和格雷迪医院招募的有效性。我们将提供一个多方面的技能建设干预措施，鼓励参与者为自己和同伴倡导预防和接受初级保健服务。这些干预策略改编自最近开发的策略，并在以前的CDC资助的多地点研究中进行了测试。我们将采用随机实验设计来比较干预的效果与注意力控制组。参与者将在基线和完成干预后6个月和12个月进行评估。这项研究的主要结果将是减少无保护的性行为。次要成果将包括增加艾滋病毒初级门诊汽车的使用，并增加药物治疗的准备和进入。

DESCRIPTION (provided by applicant): HIV prevention messages have typically targeted uninfected, at-risk individuals and have focused on forestalling the acquisition of HIV. Recently, a shift in the HIV prevention field has recognized the importance of developing intervention strategies for HIV-positive individuals, since each new infection begins with someone who is already HIV-infected. Prior studies show that many HIV-positive individuals are continuing to engage in unsafe risk behaviors and that crack use is significantly associated with these risk behaviors. These data also show that crack use is negatively associated with the use of primary outpatient HIV care. The hospital or inpatient ward may be an important, yet largely untapped setting to provide prevention interventions to high-risk, HIV-positive crack users. Hospitals also provide an important setting for HIV prevention interventions with infected crack users, because hospitalization may serve as a "teachable moment" when patients are open to behavioral change interventions. Our multi-site study between the University of Miami and Emory University will be conducted at Jackson Memorial Hospital in Miami, Florida and Grady Memorial Hospital in Atlanta, Georgia. We will evaluate the efficacy of a brief, theoretically-guided, "Prevention Care Advocate" intervention with HIV-positive crack users recruited from the HIV inpatient hospital wards at Jackson and Grady hospitals. We will provide a multicomponent, skills-building intervention that encourages participants to advocate for prevention and receipt of primary care services for themselves and their peers. These intervention strategies are adapted from strategies recently developed and tested in previous CDC-funded multi-site studies. We will employ a randomized experimental design to compare the intervention's efficacy with an attention-control group. Participants will be assessed at baseline and 6 and 12 months after completing the intervention. The primary outcome of the study will be to reduce unprotected sex. Secondary outcomes will include increasing the use of HIV primary outpatient cars and increasing readiness for and entry to drug treatment.