Evidence-based multi level risk reduction for Bahamian mid-adolescents

描述(由申请人提供)：在过去的四分之一个世纪里，在实现有目的的行为改变以降低艾滋病毒/艾滋病风险方面取得了实质性进展。然而，特定的人口和社会地理亚群仍然处于高风险中，在保持有目的的行为改变方面仍然存在重大挑战。仍处于高危状态的群体包括青少年和青壮年、有色人种以及居住在转型国家和发展中国家的个人。行为风险减少干预措施继续面临的挑战包括：a)干预效果随着时间的推移而减弱；b)青春期发生的环境暴露及其反应的变化；以及c)多阶段行为干预的资源密集性，特别是在资源匮乏的环境中，如发展中国家和转型期国家。R01MH069229的竞争性更新将专注于特别高风险的人群(在艾滋病毒血清流行率为3%的巴哈马政府高中就读10年级的非洲裔青年)，并在我们正在进行的研究的基础上，提议进行一项四细胞随机对照试验，旨在应对上述四项挑战中的每一项。在我们当前资助期的过去4.5年里，美国-巴哈马研究团队一直在评估巴哈马对名为“聚焦加勒比青年”(FOYC)的10节青少年艾滋病毒预防计划和名为“加勒比知情父母和儿童一起”(CImPACT)的1小时父母监测干预措施的适应情况，方法是通过一项随机、对照的三细胞试验，涉及1360名六年级青少年和1175名他们的父母。从6个月到24个月的随访，FOYC青少年的避孕套使用、避孕套使用意向以及相关的认知和知识显著高于对照青少年。尽管FOYC很有效，但FOYC和对照组的实际避孕套使用率都低得令人担忧(例如，FOYC青少年24个月和36个月的避孕套使用率分别为30%和40%，对照组为20%和25%)。因此，巴哈马教育部和美国-巴哈马研究小组试图确定一种有效的干预措施，可以提供给巴哈马的10年级学生。在这份意见书中描述的研究中，我们建议：a)在两年内从巴哈马新普罗维登斯所有7所公立高中的172个10年级FHLE教室中招募2600名青少年(及其家长)；b)在课堂层面随机分配2400名青少年(及其家长)，从160个班级中选择四种干预条件之一：1)仅限HFLE(没有家长干预)；2)仅BFOOY(没有家长干预)；3)BFOOY PLUS IMPACT(提供给亲子双方，有六个月的家长助推器)；或4)BFOOY PLUS GFI(提供给亲子双方，有六个月的家长助推器)；C)随机将七所高中中的一所(有约12个HFLE班级和约200名学生)分配到“对照学校”，以探索学校内部可能出现的班级间污染；d)在干预后6、12、18和24个月评估对整个样本的干预效果(以及在6个月和12个月的家长中)；以及e)进行分组分析，以探索：i)在青春期的两个关键时刻接受干预的影响；ii)作为纵向试验的一部分对风险/保护行为的影响；和iii)如果随机单位是班级而不是学校，干预污染的程度。 与公共卫生相关：拟议的研究将使我们能够确定在青少年进入艾滋病毒风险最高的年龄时对他们进行干预的最佳方式，无论他们以前是否曾接触过艾滋病毒风险降低工作。该项目将帮助我们阐明父母可能能够在一个正式的、以学校为基础的艾滋病毒预防计划中扮演的角色，以帮助保护他们的青少年。这项研究既及时，又具有重大的全球意义，解决了全世界艾滋病研究人员面临的许多关键研究问题。1

DESCRIPTION (provided by applicant): Over the last quarter century, substantial progress has been made in effecting purposeful behavioral change to reduce HIV/AIDS risk. Nevertheless, specific demographic and socio-geographic sub-groups remain at high risk and substantial challenges in maintaining purposeful behavioral change persist. Among those groups remaining at high risk are adolescents and young adults, persons of color, and individuals residing in transitional and developing countries. Challenges that have continued to confront behavioral risk reduction interventions include: a) waning intervention effects over time; b) changing environmental exposures and responses thereto that occur during adolescence; and c) the resource intensive nature of multiple session behavioral interventions especially in resource poor settings such as developing and transitional countries. This competitive renewal of R01MH069229 will focus on a particularly high risk population (youth of African descent attending Grade 10 in government high schools in The Bahamas, a nation with an HIV sero- prevalence of 3%) and proposes a four-cell, randomized, controlled trial designed to address each of the four challenges outlined above, building upon our ongoing research. During the past 4.5 years in our current funding period, the US-Bahamian research team has been evaluating the Bahamian adaptation of a 10- session adolescent HIV prevention program entitled "Focus on Youth in The Caribbean" (FOYC) and the 1- hour adapted parental monitoring intervention entitled "Caribbean Informed Parents and Children Together" (CImPACT) through a randomized, controlled three-celled trial involving 1360 Grade 6 youth and 1175 of their parents. Beginning at the 6 months follow-up and extending through 24 months follow-up, condom-use, condom-use intention, and relevant perceptions and knowledge were significantly higher among FOYC youth compared to control youth. Despite the efficacy of FOYC, the and 36 (preliminary data) actual rates among both FOYC and control youth are concerningly low (e.g. condom-use rates at 24 months and 36 months was 30% and 40% among FOYC youth and 20% and 25% among controls). Therefore, the Department of Education of The Bahamas and the US-Bahamian Research Team seek to identify an effective intervention that can be delivered to Grade 10 students in The Bahamas. In the research described in this submission, we propose to: a) Recruit 2600 youth (and their parents) from 172 Grade 10 FHLE classrooms over two years from all 7 government high schools in New Providence, The Bahamas; b) Randomly assign at the level of the classroom 2400 youth (and their parents) from 160 classes to one of four intervention conditions: 1) HFLE only (no parent intervention); 2) BFOOY only (no parent intervention); 3) BFOOY plus ImPACT (delivered to parent-youth dyads with a six month parent booster); or 4) BFOOY plus GFI (delivered to parent-youth dyads with a six month parent booster); c) Randomly assign one of the seven high schools (with ~12 HFLE classes and ~200 students) to a "control school" condition to explore possible class-to-class contamination within schools; d) Assess intervention effects on the entire sample at 6, 12, 18 and 24 months post-intervention (and among parents at 6 and 12 months); and e) Conduct sub-group analyses to explore: i) the impact of interventions received at two critical junctures during adolescence; ii) the effect of being part of a longitudinal trial on risk/protective behaviors; and iii) the extent of intervention contamination if the unit of randomization is the class rather than the school. PUBLIC HEALTH RELEVANCE: The proposed research will allow us to determine the best way to intervene with youth as they enter into the age of greatest HIV risk whether they have or have not had previous exposure to HIV risk reduction efforts. The project will help us to elucidate the role that parents may be able to assume in collaboration with a formal, school-based HIV prevention program to help protect their youth.. This research is both timely and of great global importance addressing many of the key research questions confronting AIDS researchers throughout the world. 1