Dr. Spielberg's goal with this award is to gain the multidisciplinary tools required to become a successful independent investigator in HIV prevention and substance abuse health services research. Her current research involves a randomized evaluation of factors influencing HIV testing acceptance among injection drug users (IDU), including methods of sampling (oral vs. blood), methods of assay (rapid vs. standard), and methods of risk-reduction (written materials providing information and recommendations on HIV risk reduction vs. face- to-face client-centered counseling). This research demonstrates that needle exchange clients are more likely to accept and complete testing when offered the option of receiving written materials instead of face-to-face risk-reduction counseling. Now it is crucial to compare the impact of these two counseling strategies on HIV risk behaviors, in order to develop optimal risk reduction strategies for IDU. However, to accomplish this the applicant requires additional training in the design, implementation, and cost-effectiveness analysis of behavioral interventions to reduce HIV risk among substance users and their partners. This proposal will provide these skills through an integrated approach employing collaboration with a multidisciplinary team of established research mentors and targeted course work designed to build upon the candidate's background in family medicine and prior research studies, in order to expand her theoretical and methodological areas of expertise. As part of this training a series of three focused, supervised research studies are proposed, to include: 1) a randomized comparison of the impact of client-centered HIV counseling (Project Respect model) vs. written materials to decrease reported HIV risk behaviors in a cohort of IDU undergoing HIV testing. 2) A retrospective analysis of data available in Seattle from the HIV Network for Prevention Trials (HIVNET) national cohort of over 4000 high risk individuals, including 1124 IDU, to assess the association of observed rates of incident HIV infection with changes in reported risk behaviors. And 3) A cost-effectiveness analysis of HIV counseling and testing strategies using data from an ongoing randomized comparison of acceptance rates (to be completed 3/2000), data on risk behavior change with counseling interventions proposed in study number 1, and data linking reported behaviors with actual HIV incidence proposed in study number 2, to estimate the impact of these counseling strategies on HIV incidence among IDU. In addition, the cost-effectiveness of the two interventions on Quality Adjusted Life Years Saved (QALYS) will be determined, using published data linking HIV infection to QALYS, which will allow communities to compare the cost and benefits of these HIV prevention efforts to other prevention efforts using the same unit of measure. The applicant's goal with this funding is to gain critical new skills in the design, implementation, and analysis of behavioral interventions to reduce HIV risk among substance users and their partners, while providing new information to help guide the selection of effective HIV prevention interventions for these populations.
