Reducing HIV risk behavior in depressed and non-depressed older adults with HIV

 描述(申请人提供)：到2020年，美国70%的艾滋病毒携带者将达到50岁，这在很大程度上是由于临床护理的改善，更有效的抗逆转录病毒治疗方案，以及越来越多的新诊断为≥≥50岁的人。据估计，37%的性活跃的老年艾滋病毒携带者(OPLWH)继续从事艾滋病毒传播的性行为。尽管OPLWH一再呼吁采取二级预防干预措施，以减少无避孕套的性行为，但对于这一群体，没有适合年龄的循证二级预防干预措施。许多妇幼保健院无法提供面对面的二级预防服务，因为艾滋病毒和年龄相关的耻辱、并存的心理和身体健康状况使前往提供艾滋病毒预防干预措施的地点的旅行复杂化，或者地理上的孤立。OPLWH中抑郁症和神经认知障碍的高比率可能会使旨在减少这一群体艾滋病毒传播的干预措施的参与进一步复杂化，并减少其益处。这项拟议的研究是一项随机对照试验，采用5次电话管理的动机访谈加行为技能培训(Telemi+BST)干预，以减少50岁以上HIV阳性成年人的无套性行为。美国将通过服务艾滋病毒感染者的社区组织、艾滋病毒社会服务提供者的农村网络、艾滋病毒相关杂志和网站上发布的广告以及在线约会论坛，在美国各地招募336名不同地理和种族的OPLWH。符合条件的人将被随机分配接受5节Telemi+BST干预或相当于5节电话管理的应对有效性培训(TeleCET)控制干预。研究治疗师将是位于俄勒冈州波特兰的社区艾滋病毒社会服务提供者。自我管理的问卷将评估人口统计特征，以及避孕套的使用知识、信念、态度和技能，而简短的电话采访将评估性行为、物质使用和精神症状。电话管理的神经认知评估也将在基线上进行。研究目的1将测试Telemi+BST在减少与HIV阴性或未知HIV血清状态伴侣发生无避孕套保护的肛交和阴道性交次数方面的效果，并检查干预效果的心理社会中介因素。研究目标2将测试Telemi+BST在减轻轻度抑郁症参与者抑郁症状方面的有效性。研究目标3将检验基线抑郁症状严重程度对Telemi+BST疗效的调节作用。其他探索性分析将检查神经认知功能、VL和参与者的性伴侣使用暴露前预防(PrEP)对Telemi+BST疗效的影响。这项研究可能会产生一种以证据为基础、以人为中心的干预措施，满足妇产科医生独特的性关系和健康需求，并减少艾滋病毒传播给他们艾滋病毒阴性的性伴侣。

 DESCRIPTION (provided by applicant): By 2020, 70% of people living with HIV in the United States will be ≥50 years of age due, in large part, to improved clinical care, more efficacious antiretroviral therapy regimens, and the increasing number of persons newly diagnosed with HIV ≥50 years of age. An estimated 37% of sexually active older people living with HIV (OPLWH) continue to engage in HIV transmission sexual behaviors. In spite of repeated calls for secondary prevention interventions to reduce condomless sex in OPLWH, no age-appropriate, evidence-based secondary prevention interventions exist for this group. Many OPLWH cannot engage in face-to-face secondary prevention services because of HIV- and age-related stigma, comorbid mental and physical health conditions that complicate travel to venues in which HIV prevention interventions are delivered, or geographic isolation. High rates of depression and neurocognitive impairment in OPLWH may further complicate engagement in, and reduce benefits of, interventions that aim to reduce HIV transmissions in this group. The proposed study is a randomized controlled trial of a 5-session telephone-administered motivational interviewing plus behavioral skills training (teleMI+BST) intervention to reduce condomless sex in HIV-positive adults 50-plus years of age. A geographically and ethnically/racially diverse sample of 336 OPLWH will be recruited across the U.S. through community-based organizations that serve people living with HIV, rural networks of HIV social service providers, advertisements placed in HIV-related magazines and websites, and online dating forums. Eligible persons will be randomly assigned to receive either a 5-session teleMI+BST intervention or an attention equivalent 5-session telephone-administered coping effectiveness training (teleCET) control intervention. Study therapists will be community-based HIV social service providers located in Portland, OR. Self- administered questionnaires will assess demographic characteristics, and condom use knowledge, beliefs, attitudes, and skills, while a brief telephone interview will assess sexual behavior, substance use, and psychiatric symptoms. A telephone-administered neurocognitive assessment will also be conducted at baseline. Study Aim 1 will test the efficacy of teleMI+BST to reduce occasions of non-condom protected anal and vaginal intercourse with HIV-negative or unknown HIV serostatus partners and examine psychosocial mediators of intervention efficacy. Study Aim 2 will test the efficacy of teleMI+BST to reduce depressive symptoms in mildly depressed participants. Study Aim 3 will test the moderating effect of baseline depressive symptom severity on teleMI+BST efficacy. Additional exploratory analyses will examine the impact of neurocognitive functioning, VL, and pre-exposure prophylaxis (PrEP) use by participants' sexual partners on teleMI+BST efficacy. This study may yield an evidence-based, person-centered intervention that meets the unique sexual relationship and health needs of OPLWH and reduces the transmission of HIV to their HIV- negative sexual partners.