Couples Motivational Interviewing to reduce drug use and HIV risk in vulnerable male couples

项目摘要 为性少数男性（SMM）制定有效的药物使用干预措施， 公共卫生优先。SMM -特别是35岁以下的人-仍然占新艾滋病毒感染者的大多数 在美国，35-68%的感染是在主要或主要关系之间传播的。 伙伴药物使用是SMM的性传播HIV风险行为（TRB）的一个明确相关因素 一般来说，吸毒和艾滋病毒TRB之间的关联是可比的单一和合作伙伴的SMM。 尽管在个人和团体中取得了成功，但在夫妇中应用MI的情况很少， 结果好坏参半。多元智能是为个人开发的，它对辅导员提供的指导相对较少 当伴侣没有同样准备好改变或一方反对健康行为时。斯塔克斯博士 (PI)已经投入了十多年的研究来开发一个新的框架来进行MI 和一对夫妇。我们的范式将夫妻（而不是关系中的一方）视为客户， 提供了管理冲突和促进共同目标和变革计划发展的战略。 我们的团队包括行为干预发展和艾滋病毒预防方面的专家， SMM现在提出了一项夫妇健康项目（CHP）的疗效试验。CHP是第一个多会话 夫妇MI药物使用和艾滋病毒风险降低干预，旨在用于辅导员和其他心理 为SMM提供循证药物使用治疗的卫生专业人员。该项目直接生成 关于DA 043422（PI-1）的干预开发工作和试点随机对照试验（RCT）结果， Starks）。结果表明，CHP与药物使用和性风险的显着减少有关 在最高风险的夫妇中。 我们现在提出了一个多站点试验的权力，以测试CHP的疗效和评估假定的主持人 (and在我们的试点工作中发现。参与者包括180对男性夫妇，其中至少一方 年龄18 - 34岁; HIV阴性;最近（过去30天）报告吸毒和性HIV TRB。生物 药物使用的标志物（尿液分析）以及细菌性传播感染证实了自我报告 毒品使用和艾滋病毒TRB数据。为了提高普遍性和可行性，夫妇将在网上招募， 美方在伴侣双方完成远程基线评估后，这对夫妇被随机分配到 无论是卫生防护中心的干预措施，还是一次夫妻艾滋病毒检测和咨询（ 男性夫妇的性健康），由干预人员通过健康保险和责任法案投诉ZOOM以远程保健形式提供 基于地理上不同的医疗和研究机构（纽约市;底特律，密歇根州;和夏洛茨维尔， VA）。SMM完成干预后3、6和9个月的随访评估（远程）。

Project Summary The development of effective drug use interventions for sexual minority men (SMM) in relationships is a public health priority. SMM – particularly those under age 35 – continue to represent the majority of new HIV infections in the US and 35-68% of these infections are transmitted between main or primary relationship partners. Drug use is a well-established correlate of sexual HIV transmission risk behavior (TRB) for SMM generally and associations between drug use and HIV TRB are comparable for single and partnered SMM. Despite success with individuals and groups, applications of MI with couples are rare and initially produced mixed results. Developed for use with individuals, MI provided relatively little guidance to counselors when partners were not equally ready to change or one partner argued against a health behavior. Dr. Starks (PI) has devoted more than a decade of research to the development of a novel framework for conducting MI with a couple. Our paradigm views the couple (rather than one partner in the relationship) as the client and offers strategies for managing conflict and promoting the development of shared goals and change plans. Our team, which includes experts in behavioral intervention development and HIV prevention with SMM, now proposes an efficacy trial of the Couples Health Project (CHP). CHP is the first multi-session couples MI drug use and HIV risk reduction intervention intended for use by counselors and other mental health professionals who deliver evidence-based substance use treatment to SMM. The project builds directly on the intervention development work and pilot randomized controlled trial (RCT) results of DA043422 (PI- Starks). Results indicated that CHP was associated with significant reductions in drug use and sexual risk taking among couples who were at the highest risk. We now propose a multi-site trial powered to test the efficacy of CHP and evaluate putative moderators (and mediators) identified in our pilot work. Participants include 180 male couples in which at least one partner is age 18 – 34; HIV negative; and reports recent (past 30 day) drug use and sexual HIV TRB. Biological markers for drug use (urine assay) as well as bacterial sexually transmitted infections corroborate self-reported drug use and HIV TRB data. To increase generalizability and feasibility, couples will be recruited online across the US. Following completion of a remote baseline assessment by both partners, the couple is randomized to either the CHP intervention or a single session of couples HIV testing and counseling (the standard of care for male couples’ sexual health) delivered in a telehealth format via HIPAA complaint ZOOM by interventionists based at geographically diverse medical and research facilities (New York City; Detroit, MI; and Charlottesville, VA). SMM complete follow-up assessments (remotely) 3, 6, and 9-months post-intervention.