DVD-based HIV/HCV Intervention for Drug-Involved Latino Criminal Justice Clients

描述（由申请人提供）：最近的估计表明，囚犯的艾滋病毒感染率是一般人群的四倍，即1.7% (BJS 2006； CDC, 2008ab)，丙型肝炎病毒感染率估计在20%至40%之间（CDC, 2003）。拉美裔囚犯约占美国囚犯总数的31%。作为NIDA刑事司法药物滥用治疗研究（CJ-DATS）合作协议的一部分，以前为非洲裔美国人和白人刑事司法客户开发了一种基于dvd的同伴干预措施，并发现它对减少性风险有效；然而，没有针对拉丁裔罪犯的干预措施。采用阶段模型方法和信息-动机-行为（IMB）模型，拟议项目的总体目标是为佛罗里达州迈阿密涉及毒品的拉丁裔刑事司法客户开发并试点测试一种新的、文化上合适的艾滋病毒/丙型肝炎病毒干预方案。本研究阶段1a部分的具体目的如下：(1)通过关键线人访谈和焦点小组，确定影响拉丁裔异性恋刑事司法客户艾滋病毒/HCV风险和预防行为的显著个人和文化因素；(2)针对社区拉丁裔异性恋刑事司法客户，包括形成性定性研究中确定的风险因素，开发一种简短的、基于同行交付的基于dvd的HIV/HCV干预措施；(3)制定和完善干预手册和培训程序。阶段1b的具体目标是：(1)通过招募210名强制接受药物滥用治疗的拉丁裔罪犯，试点测试和评估基于dvd的艾滋病毒干预的有效性；(2)评估参与者和干预者对这种新型DVD干预的可接受性。参与者将从当地社区机构招募，该机构为法院授权的个人提供门诊药物滥用治疗服务。符合条件的参与者将自我认定为拉丁裔/西班牙裔，年龄在18至49岁之间，异性恋，所有参与者都将参与刑事司法系统。参与者将被随机分为干预组和等候组。干预包括一个以dvd为基础的小组会议，由干预专家协助。将对性风险、药物使用、精神健康和背景信息进行评估，并在基线时提供艾滋病毒/丙型肝炎病毒检测，并在干预期后3个月再次进行评估。在干预期结束时，每位参与者将完成一份可接受性问卷，干预师将完成一份评估治疗忠实度的清单。假设在基线和随访期间，干预组的性风险和药物使用行为都比对照组减少。该项目具有创新性，因为它将为拉丁裔罪犯开发一种基于dvd的、适合文化和特定语言的艾滋病毒/丙型肝炎病毒预防干预措施。这项拟议的研究意义重大，因为它有望产生一种简短的艾滋病毒/丙型肝炎病毒干预措施，可以在刑事司法系统内实施，并针对高风险群体。

DESCRIPTION (provided by applicant): Recent estimates place the rate of HIV infection among prisoners at four times that of the general population, or 1.7% (BJS 2006; CDC, 2008ab), and rates of HCV infection is estimated to be between 20 and 40% (CDC, 2003). Latinos account for approximately 31% of all inmates in the United States. As part of NIDA's Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement, a peer delivered DVD-based intervention for African-American and White criminal justice clients was previously developed and found effective in reducing sexual risk; however, no intervention was developed for Latino offenders. Using a stage model approach and the Information-Motivations-Behavioral (IMB) model, the overall goals of the proposed project is to develop and pilot test a novel, culturally-appropriate HIV/HCV intervention protocol for drug- involved Latino criminal justice clients in Miami, Florida. The specific aims for the Stage 1a portion of the study are the following: (1) to identify the salient individual and cultural factors that influence HIV/HCV risk and preventive behaviors among heterosexual Latino criminal justice clients through key informant interviews and focus groups; (2) to develop a brief, peer-delivered DVD-based HIV/HCV intervention targeting heterosexual community-based Latino criminal justice clients that include risk factors identified in the formative qualitative research; and (3) to develop and refine an intervention manual and training procedures. The specific aims for Stage1b are: (1) to pilot test and evaluate the effectiveness of the DVD-based HIV intervention by recruiting 210 Latino offenders mandated to substance abuse treatment; and (2) to evaluate both participant and interventionist acceptability of this novel DVD intervention. Participants will be recruited from a local community agency that provides outpatient substance abuse treatment services for court-mandated individuals. Eligible participants will be self-identified Latino/Hispanic, between the ages of 18 and 49, heterosexual, and all participants will be involved with the criminal justice system. Participants will be randomized into either an intervention or a wait-list control condition. The intervention consists of one DVD-based group session facilitated by an interventionist. Sexual risk, drug use, mental health, and background information will be assessed and HIV/HCV testing provided at baseline, and assessed again at 3 months after the intervention session. At the end of the intervention session, each participant will complete an acceptability questionnaire, and the interventionist will complete a checklist to assess treatment fidelity. It is hypothesized that both sexual risk and drug use behaviors will decrease between baseline and follow-up for the intervention group compared to the control group. The project is innovative because it will develop a DVD-based, culturally-appropriate and language specific, HIV/HCV prevention intervention for Latino offenders. The proposed research is significant, because it is expected to produce a brief HIV/HCV intervention that can be implemented within the criminal justice system and targets a high risk group. PUBLIC HEALTH RELEVANCE: The proposed study is relevant to public health because it focuses on two major public health concerns - HIV/HCV infection; and it also targets a high risk group in drug-involved Latino offenders. Because Latinos are the fastest growing and largest minority group in the United States, the proposed intervention will have a significant impact. The proposed study is relevant to NIDA's mission by addressing the strategic goal of diminishing the spread of drug abuse-related HIV and minimizing the associated health and social consequences of the disease.