Brief Care-based HIV Prevention for Newly Diagnosed Men

描述(由申请人提供)：最近艾滋病毒诊断、性传播感染和危险行为的增加表明，需要进行研究，以确定整合在艾滋病毒初级保健环境中的有效积极预防干预措施，以减少艾滋病毒阳性个人的传播危险行为。特别是，对那些新确诊的人没有有效的干预措施。艾滋病毒确诊后的一段时间可能是一个“可教的时刻”，以鼓励减少危险行为或保持较低的危险。这是一个机会之窗，因为收到艾滋病毒诊断后的第一年可能是降低风险的关键时期，特别是对男性来说。这项研究的主要目的是评估基于信息、动机和行为技能(IMB)模式的简短积极预防干预的有效性，该干预在护理和治疗新诊断的HIV阳性男男性行为者(MSM)中提供，以减少传播危险行为。这项拟议的为期五年的研究将随机分配300名在前3个月内新诊断的性行为活跃、艾滋病毒阳性的MSM，接受1)全面护理标准(CSC)或2)简单风险降低+CSC(BRR)，这是一种基于IMB模型的简短个人干预措施，解决性传播风险行为和药物使用问题。BRR将跟踪最初的医生就诊情况，并将降低风险纳入个性化和相关医疗的背景下，以加强对健康保护信息的吸收。将在基线、干预后(3-)以及6、9、12个月的随访点收集信息、动机影响、行为技能、性风险行为和药物使用的评估，以确定干预结果的效果。据假设，与被分配到比较条件(CSC)的新诊断的HIV阳性男性相比，BRR干预措施中的那些人的HIV性传播风险行为、延迟发病到首次无保护的性行为以及减少药物使用的比率将显著降低。随着时间的推移，传播风险行为的减少将通过IMB模型的关键要素进行预测，并将展示干预效果的中介作用。如果成功，这项研究将确定一种简短的积极预防干预措施，可以在护理环境中为新诊断为艾滋病毒的男性实施。 需要公共卫生相关性研究来确定有效的积极预防干预措施，这些干预措施可以纳入艾滋病毒治疗环境，以减少艾滋病毒阳性个人的危险行为。这项研究将首次评估一项简短的降低风险干预措施，以减少新诊断的艾滋病毒男性中的传播风险行为，这项研究具有科学意义，即在艾滋病毒阳性诊断后及早干预是否最大限度地提供了降低风险的“可教时刻”。拟议的干预研究具有重要意义，并与公共卫生高度相关，这主要是因为以新诊断的人为目标的重要性。艾滋病毒诊断后的早期干预侧重于一段时间段，这段时间可能会由于风险行为水平的波动而增加艾滋病毒传播的可能性，因为人们正在适应诊断，提供机会保持在了解艾滋病毒+状态后启动的风险降低，并通过将降低风险纳入多学科护理方法来协助过渡到医疗保健。

DESCRIPTION (provided by applicant): Recent increases in HIV diagnoses, sexually transmitted infections, and risk behavior indicate that research is needed to identify effective positive prevention interventions integrated within HIV primary care settings to reduce transmission risk behavior among HIV positive individuals. In particular, no effective interventions exist for those newly diagnosed. The time period after HIV diagnosis may be a `teachable moment' to motivate reductions in risk behavior or maintenance of lower risk. This is a window of opportunity, as the first year after receiving an HIV diagnosis may be a critical period for risk reduction, especially for men. The primary objective of this study is to evaluate the efficacy of a brief positive prevention intervention, based on the Information, Motivation and Behavioral Skills (IMB) Model, provided within the care and treatment of newly diagnosed HIV-positive men who have sex with men (MSM) to reduce transmission risk behavior. The proposed five-year study will randomly assign 300 sexually active, HIV- positive MSM, newly diagnosed within the prior 3 months, to receive either 1) comprehensive standard of care (CSC) or 2) Brief Risk Reduction + CSC (BRR), a brief individual intervention based on the IMB model that addresses sexual transmission risk behavior and substance use. BRR will follow the initial physician visit and integrate risk reduction in the context of personalized and relevant medical treatment to enhance the uptake of health-protective information. Assessments of information, motivational influences, behavioral skills, sexual risk behavior, and substance use will be collected at baseline, post-intervention (3-), and 6-, 9-, 12- month follow-up points to determine intervention outcome effects. It is hypothesized that, relative to newly diagnosed HIV- positive men assigned to the comparison condition (CSC), those in the BRR intervention will exhibit significantly lower rates of HIV sexual transmission risk behavior, delayed onset to first unprotected sexual activity, and reduced substance use. Over time, reductions in transmission risk behaviors will be predicted by key elements of the IMB model and will demonstrate mediation of intervention effects. If successful, this research will identify a brief positive prevention intervention that can be implemented in the care setting for newly HIV diagnosed men. PUBLIC HEALTH RELEVANCE Research is needed to identify effective positive prevention interventions that can be integrated within HIV treatment settings to reduce risk behavior among HIV positive individuals. This research will be the first to evaluate a brief risk reduction intervention to reduce transmission risk behavior among newly HIV diagnosed men, with scientific relevance regarding whether intervening early after an HIV+ diagnosis maximizes a `teachable moment' for risk reduction. The proposed intervention research is significant and highly relevant to the public health, due primarily to the importance of targeting those newly diagnosed. Intervening early after the HIV diagnosis focuses on a time period that may have increased likelihood of HIV transmission due to fluctuating levels of risk behavior as one adjusts to the diagnosis, provides an opportunity to maintain risk reduction initiated after learning of HIV+ status, and assists in the transition to medical care through inclusion of risk reduction in a multidisciplinary approach to care.