STI/HIV Risk, Services, and Drug Use For Young Arrestees

描述（由申请人提供）：大量吸毒青少年进入少年司法系统时面临性传播感染（STI）、衣原体和淋病、可治疗且通常无症状的细菌感染的风险，这些感染会增加艾滋病毒风险。然而，目前对少年犯的性传播感染监测是以监狱为基础的，通常仅限于教养设施（尽管大多数少年犯没有被监禁），导致许多未被发现的病例增加了公共健康风险。设计和扩大更有效的性传播感染健康干预措施需要关于所有违法者（不仅仅是那些被监禁者）中性传播感染与吸毒和危险行为之间关系的数据。此外，在社区中对少年犯实施的减少性传播感染/艾滋病毒风险的干预措施很少。因此，有必要进一步了解青少年司法系统“前端”青少年的吸毒和性风险行为，开发新的筛查方法，在青少年司法程序的早期发现感染，并为更广泛的青少年群体提供更有效的预防和治疗服务。该赠款拟在希尔斯伯勒县（FL）青少年评估中心（JAC）实施性传播感染评估和尿液筛查（衣原体和淋病）协议;分析吸毒、性风险行为和性传播感染率之间的关系;并确定性传播感染相关服务需求和障碍，以扩大对这一服务不足的高风险人群的性传播感染检测和服务。未来计划的研究将进一步探讨犯罪青年的性传播感染相关服务需求，并在对照临床试验中开发，试点和实施性传播感染风险降低计划。将从连续入住JAC的900名符合条件的违法青年中收集摄入评估和STI尿液测试的数据（分层以产生450名女性（一个重要但研究不足的亚群）。组织数据将来自青少年司法和服务提供者记录、感染和卫生服务地点的地理编码数据以及40名工作人员的访谈。 将从希尔斯伯勒县卫生部门收集STI阳性参与者的STI治疗和重新检测的后续数据。JAC和州/县卫生官员致力于与研究小组在这个和未来的项目合作。有四个研究目标：目标1：评估高风险少年犯（即活跃吸毒者和有吸毒风险者）的性传播感染/艾滋病毒风险状况，并将其与低风险罪犯进行比较。目标2：查明少年犯对性传播感染和艾滋病毒预防服务的需求以及提供这些服务的组织和个人障碍。目标3：确定进入少年司法系统的少年犯中性病（衣原体和淋病）和自我报告的艾滋病毒感染率。目标4：确定性传播感染阳性青年返回接受治疗的百分比，并分析与提供和接受治疗相关的因素。

DESCRIPTION (provided by applicant): Large numbers of drug-involved adolescents enter the juvenile justice system at risk for the sexually transmitted infections (STIs) chlamydia and gonorrhea, treatable and often asymptomatic bacterial infections that increase HIV risk. However, current STI surveillance for juvenile offenders is symptom-based and typically limited to correctional facilities (although most juvenile offenders are not incarcerated), resulting in many undetected cases that increase public health risk. Designing and expanding more effective STI health interventions require data on how STI infection among all delinquents (not just those incarcerated) is related to drug use and risk behaviors. Moreover, few STI/HIV risk reduction interventions have been implemented for adolescent offenders in the community. Thus, there is a need to further our understanding of drug use and sex risk behaviors among youth at the "front end" of the juvenile justice system, to develop new screening methods that identify infections early in the juvenile justice process, and to provide more effective prevention and treatment services to a broader segment of this population. This grant proposes to implement an STI assessment and urine screening (for chlamydia and gonorrhea) protocol in the Hillsborough County (FL) Juvenile Assessment Center (JAC); analyze relations among drug use, sex risk behaviors and STI infection rates; and identify STI-related service needs and impediments to expanding STI testing and services for this underserved high-risk population. Future planned research will further explore the STI-related service needs of delinquent youth, and develop, pilot, and implement an STI risk reduction program in a controlled clinical trial. Data from an Intake Assessment and STI urine tests will be collected from a sample of 900 eligible delinquent youth consecutively admitted to the JAC (stratified to yield 450 females (an important but understudied subpopulation). Organizational data will be drawn from juvenile justice and service provider records, geocoded data on infections and health service locations, and 40 staff interviews. Follow-up data on STI treatment and retesting will be collected from the Hillsborough County Health Department for STI-positive participants. JAC and State/County health officials are committed to collaborating with the research team on this and future projects. There are four study aims: AIM 1: To assess STI/HIV risk profiles in high-risk juvenile offenders (i.e. active drug users and those at risk for drug use) and compare them to low-risk offenders. AIM 2: To identify STI and HIV prevention service needs among juvenile offenders and the organizational and individual barriers to delivering these services. AIM 3: To determine STI (chlamydia and gonorrhea) and self-reported HIV prevalence rates among juvenile offenders entering the juvenile justice system. AIM 4: To determine the percentage of STI-positive youth who return for medical treatment, and analyze the factors associated with provision and receipt of treatment.