Experimental Analysis of HIV Risk Assessment Reactivity in South African Clinics

描述(由申请人提供)：本修订申请是对项目公告05-090“行为科学中的方法学和测量”的回应，提出了一项行为评估反应性的实验分析，同时为南非性传播疾病(STD)临床患者提供了一种有前景的艾滋病毒预防干预措施的额外疗效数据。我们的主要目的是在南非开普敦的性病门诊患者样本中检查艾滋病毒风险行为评估对艾滋病毒风险行为和艾滋病毒预防干预结果的影响的公共卫生影响和潜在机制，该地区受到艾滋病毒和艾滋病毒相关污名的严重影响。在所罗门四组实验设计的扩展中，1500名患者(50%)妇女将被随机分配到不同情况下。对于另一种基线评估，实验采用2(艾滋病毒风险降低干预：增强与护理咨询标准)×3(基线行为访谈：无与一般与详细)析因设计。这两个实验性的基线行为访谈类似于目前在主要艾滋病毒预防试验中使用的访谈，但不同之处在于它们要求参与者关注特定的危险行为实例。我们预计，详细面谈将导致比一般面谈更多的评估反应性，并且仅详细面谈将导致风险行为的减少。我们还将测试基于自我意识理论变体的假设，这些假设涉及调节和调节评估反应性的机制。这项研究的结果将与预防科学领域以及南非的艾滋病毒预防有关。这项研究将首次在实验上将基线评估的影响与有效促进安全性行为的艾滋病毒预防干预的影响分开。这项研究还将在健康领域首次探索评估反应发生的认知和人际过程，以及自我报告风险行为后适度行为变化的因素。关于公共卫生惠益，这些结果将有助于确定如何最大限度地发挥向社区组织传播的预防干预措施的效果，并可能有助于制定简明、增强动力的减少艾滋病毒风险干预措施，利用评估的反应性。结果也将与杀微生物剂试验相关，这些试验经常使用重复的详细行为评估，这可能会改变参与者使用杀微生物剂的意愿，并扭曲结果。

DESCRIPTION (provided by applicant): This revised application, submitted in response to Program Announcement 05-090 "Methodology and Measurement in the Behavioral Sciences," proposes an experimental analysis of behavioral assessment reactivity, while generating additional efficacy data on a promising HIV prevention intervention for South African sexually transmitted disease (STD) clinic patients. Our primary aim is to examine the public health impact and mechanisms underlying the effects of HIV risk behavior assessment on HIV risk behavior and on HIV prevention intervention outcomes in a sample of STD clinic patients in Cape Town, South Africa, an area severely affected by HIV and HIV-related stigma. 1500 patients (50%) women will be randomly assigned to condition in a extension of the Solomon Four Group experimental design. With an additional type of baseline assessment, the experiment is a 2 (HIV risk reduction intervention: enhanced vs. standard of care counseling) x 3 (baseline behavioral interview: none vs. general vs. detailed) factorial design. The two experimental baseline behavioral interviews are analogous to those currently used in major HIV prevention trials, and differ in the amount they require participants to focus on specific instances of risk behavior. We expect that the detailed interview will lead to more assessment reactivity than the general interview and that the detailed interview alone will lead to reductions in risk behavior. We will also test hypotheses based on variants of self-awareness theory regarding the mechanisms that mediate and moderate assessment reactivity. Results of this study will be relevant to the field of prevention science as well as to HIV prevention in South Africa. This study will be the first to experimentally disentangle the influence of baseline assessments from that of an HIV prevention intervention effective at promoting safer sexual behaviors. The study will also be the first in the health domain to explore the cognitive and interpersonal processes by which assessment reactivity occurs and the factors that moderate behavior change following self-reports of risk behavior. Regarding public health benefits, these results will help to determine how to maximize the effects of prevention interventions disseminated to community based organizations, and may help to develop brief, motivation-enhancing HIV risk-reduction interventions that capitalize on assessment reactivity. Results will also be relevant to microbicide trials that often use repeated detailed behavioral assessments, which may alter participants' willingness to use the microbicide and distort the outcomes.