Preventing Rural Thai Methamphetamine Abuse and HIV by Community Mobilization

描述（由申请方提供）：R 01 DA 14702 -01的修订后竞争性继续申请继续我们的行为干预，以降低泰国北方青少年和年轻成人与非注射甲基苯丙胺使用相关的HIV性风险。在我们赠款的前五年，我们描述了MA使用和艾滋病毒感染性风险的变化。2004年，我们开始研究程序，并于2006年5月完成入组（n=987）;数据收集于2007年7月结束。我们在试验中有很好的招募、参与和保留（>90%），我们现在将重点转移到偏远的农村地区。民族志显示，MA和其他非注射毒品的使用在农村青年中很普遍，并与艾滋病毒风险有关。我们寻求通过促进由受影响社区制定并与受影响社区一起制定的社区一级结构性干预措施来预防MA滥用和艾滋病毒风险。我们的具体目标是：（1）遵循“连接保护”（C2 P）方法，促进社区动员、社区能力建设和社区参与，以促成结构性变革，从而降低MA和其他非注射毒品感染艾滋病毒的风险。(2)在25个村庄的5个社区集群中进行为期3年的C2 P随机分组试验，并将其在MA和性风险降低方面的疗效与附近5个社区集群中的25个村庄进行比较，这些社区集群提供HIV VCT转介。在C2 P动员之前和之后的两个15个月间隔内，将在队列中评估HIV和STI发病率、药物和性风险以及耻辱感。最后，（3）在实验社区内，使用定性过程评估数据来评估C2 P干预中产生行为改变的组成部分。目标社区的人种学将确定当地动员、能力建设和参与的优先事项。我们将从50个选定的社区中随机选择40名14-29岁的社区居民参加队列研究（n=2000），以系统地确定风险。我们将对与降低社区MA风险相关的干预措施组成部分的过程和人种学数据进行统计评估。拟议的研究采取了成功的理论接地的方法，从美国面对的问题，青年在社区一级在泰国，它促进了这种模式在国际环境。该项目提出了一项社区一级的行为干预措施，以减少泰国北方青少年和年轻成年人与非注射甲基苯丙胺使用有关的艾滋病毒性风险。我们将采用社区动员、社区能力建设和社区参与的方法，以促成结构性变革，从而降低MA和其他非注射吸毒导致艾滋病毒感染的风险，这种风险已在美国用于应对社区确定的青年毒品问题。

DESCRIPTION (provided by applicant): This revised competing continuation application of R01 DA14702-01 continues our behavioral interventions to reduce adolescent and young adult HIV sexual risks associated with non-injection methamphetamine use in northern Thailand. During the first five years of our grant, we characterized variation in MA use and sexual risks for HIV acquisition. In 2004, we started study procedures and enrollment was completed (n=987) in May 2006; data collection ends in July 2007. We have had excellent recruitment, participation and retention (>90%) in the trial and we now shift our focus to remote, rural areas. Ethnography shows MA and other non-injection drug use is pervasive among rural youth and associated with HIV risk. We seek to prevent MA abuse and HIV risk by promoting community-level structural interventions developed by and with the affected communities. Our specific aims are: (1) to follow the Connect to Protect (C2P) approach to promote community mobilization, community capacity building, and community involvement to forge structural changes leading to decreased MA and other non-injection drug use risks for HIV acquisition. (2) to conduct a cluster-randomized trial of C2P over 3 years in 5 community clusters of 25 villages and compare its efficacy in MA and sexual risk reduction compared to 25 villages in 5 nearby community clusters that offer referrals for HIV VCT referrals. HIV and STI incidence, drug and sex risks, and stigma will be assessed in cohorts before and for two 15 month intervals after C2P mobilization. Finally, (3) within experimental communities, to evaluate components of the C2P intervention that generate behavior change using qualitative process evaluation data. Ethnography in targeted communities will determine local priorities for mobilization, capacity building and involvement. We will recruit 40 randomly selected community dwellers aged 14-29 years of age from each of 50 selected communities to participate in a cohort study (n=2000) to systematically determine risk. We will conduct a statistical evaluation of process and ethnographic data on components of the interventions associated with reductions in community-level MA risk. The proposed study takes a successful theoretically grounded approach from the USA to confronting problems experienced by youth at the community level in Thailand, and it promotes this model in an international setting. This project proposes a community-level behavioral intervention to reduce adolescent and young adult HIV sexual risks associated with non-injection methamphetamine use in northern Thailand. We will use an approach to community mobilization, community capacity building, and community involvement to forge structural changes leading to decreased MA and other non-injection drug use risks for HIV acquisition that has been used in the USA to respond to community-identified youth drug problems.