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

描述(由申请人提供)：最近的估计显示，囚犯的艾滋病毒感染率是普通人群的四倍，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，先前为非裔美国人和白人刑事司法客户开发了基于同行交付DVD的干预措施，并被证明在减少性风险方面有效；然而，没有为拉丁裔罪犯开发干预措施。使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和试点测试一种新颖的、文化上适合的艾滋病毒/丙型肝炎病毒干预方案。1a阶段研究的具体目标如下：(1)通过主要线人访谈和焦点小组，确定影响拉美裔异性恋刑事司法客户艾滋病毒/丙型肝炎病毒风险和预防行为的显著个人和文化因素；(2)针对以社区为基础的异性恋拉美裔刑事司法客户，制定简短的、由同行提供的以DVD为基础的艾滋病毒/丙型肝炎干预措施，其中包括形成定性研究中确定的风险因素；(3)制定和完善干预手册和培训程序。Stage1b的具体目标是：(1)通过招募210名受命接受药物滥用治疗的拉丁裔罪犯，对基于DVD的艾滋病毒干预的有效性进行试点测试和评估；(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是自认为是拉丁裔/西班牙裔的人，年龄在18岁到49岁之间，是异性恋，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或等待名单控制条件。干预包括一次基于DVD的小组会议，由干预者主持。将在基线时评估性风险、药物使用、精神健康和背景信息，并提供艾滋病毒/丙型肝炎病毒检测，并在干预后3个月再次评估。在干预过程结束时，每个参与者将完成一份可接受性问卷，干预者将完成一份核对表，以评估治疗的保真度。据推测，与对照组相比，干预组的性风险和药物使用行为在基线和随访期间都将降低。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、适合文化和特定语言的艾滋病毒/丙型肝炎预防干预措施。这项拟议的研究意义重大，因为预计它将产生一种简短的艾滋病毒/丙型肝炎干预措施，可以在刑事司法系统内实施，并针对高危群体。 公共卫生相关性：拟议的研究与公共卫生相关，因为它侧重于两个主要的公共卫生问题--艾滋病毒/丙型肝炎病毒感染；它还针对涉及毒品的拉丁裔罪犯中的高危群体。由于拉美裔是美国增长最快、规模最大的少数族裔群体，因此拟议的干预措施将产生重大影响。这项拟议的研究与NIDA的使命相关，因为它解决了减少与药物滥用有关的艾滋病毒传播的战略目标，并将该疾病相关的健康和社会后果降至最低。

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.