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

在过去的四分之一个世纪里，在实现有目的的行为改变方面取得了实质性的进展 以降低艾滋病毒/艾滋病的风险。尽管如此，特定的人口和社会地理分组仍为 在维持有目的的行为改变方面仍然存在高风险和实质性挑战。其中包括 仍然处于高危状态的群体是青少年和青壮年、有色人种和居住在 转型期国家和发展中国家。行为风险降低继续面临的挑战 干预措施包括：a)干预效果随着时间的推移逐渐减弱；b)改变环境暴露和 对此的反应发生在青春期；以及c)多节课的资源密集型 行为干预，特别是在资源匮乏的情况下，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危人群(青年 非洲裔在巴哈马的公立高中就读于10年级，巴哈马是一个艾滋病毒血清携带者的国家。 3%的患病率)，并提出了一项四细胞随机对照试验，旨在解决这四种疾病 以上概述的挑战，建立在我们正在进行的研究基础上。在过去的4.5年里，在我们目前的 在资助期内，美国-巴哈马研究团队一直在评估巴哈马改编的10- 题为“以加勒比青年为重点”的青少年艾滋病毒预防方案和1- 一小时改编的父母监测干预措施，题为“加勒比知情的父母和孩子在一起” (CImPACT)通过一项随机、对照的三细胞试验，涉及1360名六年级学生和1175名 他们的父母。从6个月的随访开始，一直持续到24个月 3个月的随访、避孕套使用情况、避孕套使用意向以及相关的认知和知识 FOYC青年组显著高于对照青年组。尽管FOYC很有效，但 和36(初步数据) FOYC和对照青少年的实际避孕套使用率低得令人担忧(例如，24个月的避孕套使用率 36个月，FOYC组分别为30%和40%，对照组分别为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个 可提供给巴哈马10年级学生的有效干预措施。在描述的研究中 在这份意见书中，我们建议：a)从172名10年级FHLE中招募2600名青少年(及其家长 巴哈马新普罗维登斯所有7所公立高中两年多的教室；b) 在班级随机分配2400名青少年(和他们的家长)从160个班级到一个班级 四种干预条件：1)仅HFLE(无家长干预)；2)仅BFOOY(无家长干预) 干预)；3)BFOOY PLUS IMPACT(向亲子二人组提供六个月的父母助推器)； 或4)BFOOY加GFI(与六个月的父母助推器一起提供给亲子二人组)；c)随机 将七所高中中的一所(有~12个HFLE班级和~200名学生)分配给一所“对照学校” 调查学校内可能出现的班级间污染的情况；d)评估干预效果 在干预后6个月、12个月、18个月和24个月(以及父母在6个月和12个月时)的整个样本；以及 E)进行分组分析，以探讨：一)在两个关键时刻收到的干预措施的影响 在青春期；ii)作为纵向试验的一部分对危险/保护行为的影响；以及iii) 如果随机单位是班级而不是学校，则干预污染的程度。

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.