Reducing Alcohol-related HIV/STI Risk for Women in Reproductive Health Clinics

描述（由申请人提供）：艾滋病毒和其他性传播感染（STI）具有有害和昂贵的后果（即，不孕症、癌症、艾滋病）。滥用酒精的年轻妇女特别容易感染艾滋病毒和其他性传播感染。单一重点干预（即，那些主要关注性风险行为或酒精使用的人）只会导致与酒精相关的性风险行为的适度减少。缺乏综合的、针对性别的干预措施，以解决亲密关系和性行为中的酒精使用问题。我们提出了一个研究计划，以开发和试点测试一种综合的酒精和性风险降低干预措施，用于生殖健康和计划生育（RHFP）环境，其中可以发现许多年轻的高危女性。（18-29岁）报告有酗酒和性传播感染风险的人，并进行6- 8个焦点小组（FG），以获取有关酒精使用和关系类型如何驱动性风险行为的信息。第二，利用从FG获得的信息，我们将制定一个综合的、单独提供的简短干预（BI），该干预借鉴了经证实的策略（例如，个性化的反馈，规范性的比较，目标设定），以促进酒精和性风险的降低。我们的目标是通过开发新的组件，（a）解决性行为作为酒精中毒的原因和后果，（B）解决合作伙伴类型作为酒精使用和性风险行为的背景决定因素，以提高综合BI的功效。第三，我们将在约10名患者中对BI进行试点测试，以完善BI。第四，我们将开发一个用户友好的网站（使用以前开发和评估的材料），（a）扩大BI的范围（即，通过促进行为技能发展）和（B）促进维持初始干预收益（即，通过将BI扩展到自然环境中）。 最后，我们会进行试验计划，评估营商信息系统和网站的可行性和接受程度，并取得初步成效。对于试点试验，将招募50名有风险的年轻女性，并要求其（a）完成基线评估，（B）随机分配至基于诊所的BI（通过移动的消息补充，鼓励他们查看扩展器网站）或对照条件，以及（c）返回进行3个月随访。在基线和随访时，我们将测量酒精使用和性风险行为以及行为改变的假设介质。拟议的研究，建立在并整合了研究人员在性风险降低和酒精使用干预开发方面的专业知识，提供了BI的初步试点测试，也将使我们能够进行试点评估，干预和程序，以准备一项全面的，R 01支持的，随机对照试验，测试综合酒精和性风险降低干预的长期影响。如果成功，这项研究将导致一个有效的BI，可以传播到全国各地的性健康诊所，从而减少艾滋病毒的发病率，性传播感染，有害的酒精使用，并在年轻女性的相关健康后果。

DESCRIPTION (provided by applicant): HIV and other sexually transmitted infections (STIs) have harmful and costly consequences (i.e., infertility, cancer, AIDS). Young women who misuse alcohol are particularly vulnerable to HIV and other STIs. Single- focus interventions (i.e., those that focus primarily on sexual risk behavior or on alcohol use) result in only modest reductions in alcohol-related sexual risk behavior. Lacking are integrated, gender-tailored interventions that address alcohol use in the context of intimate relationships and sexual behavior. We propose a program of research to develop and pilot test an integrated alcohol and sexual risk reduction intervention for use in reproductive health and family planning (RHFP) settings where many young at-risk women can be found. First, we will recruit ~30 young women (18-29 years old) who report risk for alcohol misuse and STIs, and conduct 6- 8 focus groups (FGs) to elicit information regarding how alcohol use and relationship type drive sexual risk behavior. Second, using information obtained from the FGs, we will develop an integrated, individually- delivered Brief Intervention (BI) that draws upon proven strategies (e.g., personalized feedback, normative comparisons, goal setting) to promote alcohol and sexual risk reduction. We aim to enhance the efficacy of the integrated BI by developing novel components that (a) address sexual behavior as both a cause and consequence of alcohol intoxication and (b) address partner type as a contextual determinant of both alcohol use and sexual risk behavior. Third, we will pilot test the BI with ~10 patients to refine the BI. Fourth, we will deveop a user-friendly website (using previously developed and evaluated materials) that (a) broadens the scope of the BI (i.e., by promoting behavioral skills development) and (b) promotes maintenance of initial intervention gains (i.e., by extending the BI into the natural environment). Finally, we will conduct a pilot trial to evaluate the feasibility and acceptability of both the BIand the website, and obtain initial evidence of their efficacy. For the pilot trial, 50 at-risk young women will be recruited and asked to (a) complete a baseline assessment, (b) be randomized to either the clinic-based BI (supplemented by mobile messages that encourage them to view the extender website) or a control condition, and (c) return for a three-month follow-up. At both baseline and follow-up, we will measure alcohol use and sexual risk behavior as well as hypothesized mediators of behavior change. The proposed research, which builds on and integrates the investigators' expertise in sexual risk reduction and alcohol use intervention development, provides a preliminary pilot test of the BI, and will also allow us to pilot assessments, interventions, and procedures to prepare for a fully- powered, R01-supported, randomized controlled trial testing longer-term effects of the integrated alcohol and sexual risk reduction intervention. If successful, this research will lead to an efficacious BI that can be disseminated to sexual health clinics across the nation, and thereby reduce the incidence of HIV, STIs, harmful alcohol use, and related health consequences in young women.