A Self-Assessment Intervention for Young Adult Polydrug Users at Risk for HIV

描述(申请人提供)：吸毒在城市俱乐部场所很常见，摇头丸(摇头丸)和可卡因是最流行的“俱乐部”毒品。这项申请建议继续实施的父母补助金不仅记录了精神健康问题的高比率和广泛的逮捕和虐待史，而且还记录了以异性恋为主的年轻人样本中出人意料和令人震惊的高未诊断艾滋病毒感染率。家长基金现已进入第五个年头，这是一项为期18个月的纵向自然历史研究，涉及600个俱乐部和年轻人使用的处方药。这项研究的一个关键发现是，全面的健康和社会风险评估在多大程度上诱导参与者减少药物使用和性危险行为。超过70%的参与者在基线后的第一次后续评估中大幅减少了他们的物质使用。与研究完成者的定性研究表明，参与者将基线评估的强烈干预效果归因于：1)同龄同龄人友好、不加评判的实地工作人员；2)彻底和详细的评估；3)根据他们对评估项目的反应，对与药物使用有关的问题产生新的自我意识。研究完成者还报告说，风险往往会降低，正是因为这项研究没有被视为干预措施。在此背景下，拟议的5年更新项目的具体目标是：1)在佛罗里达州迈阿密的750名年龄在18至39岁的异性活跃、未接受治疗的俱乐部和处方药吸毒者中，确定基线药物滥用和性风险(包括人口统计数据、社会风险衡量标准、同伴规范、虐待史和心理健康状况)的协变量；2)通过随机分配，评估在3个月、6个月和12个月的随访中衡量的两种干预条件和等候名单对照在减少性风险和药物使用方面的相对有效性：ARM 1，面试者实施的与父母赠款中使用的基线工具类似的综合健康和社会风险评估干预(CAPI干预)；ARM 2，相同的自我管理综合评估干预(ACASI干预)；以及ARM 3，等待名单控制条件(对照)。结果衡量标准，包括过去90天的无保护性行为计数和吸毒天数，将从基线和后续行动的简要风险行为清单中获得；以及3)在每个研究分支中进行有40名参与者的定性过程评估研究，以了解研究结果和干预结果。拟议的项目意义重大，因为它满足了对高度脆弱、高风险人群进行短暂干预的需要。如果自我评估干预措施被证明在降低艾滋病毒风险方面有效，则可以以低成本和广泛的规模提供，并很可能适用于其他抵制公共卫生警告和/或专业干预的高危群体。

DESCRIPTION (provided by applicant): Drug use is normative in urban club scenes, with MDMA (ecstasy) and cocaine being the most prevalent "club" drugs. The parent grant which this application proposes to continue has documented not only high rates of mental health problems and extensive arrest and abuse histories, but also unexpectedly and alarmingly high rates of undiagnosed HIV infection among a predominately heterosexual young adult sample. The parent grant, now in its fifth year, is an 18-month longitudinal natural history study of 600 club and prescription drug using young adults. A key finding from that study is the extent to which the comprehensive health and social risk assessments induced participants to reduce their substance use and sexual risk behaviors. Over 70% of participants substantially reduced their substance use at the first follow-up assessment after baseline. Qualitative research with study completers showed that participants attributed the strong intervention effect of the baseline assessment to: 1) the friendly, non-judgmental field staff of age-peers; 2) the thorough and detailed assessments; and 3) an emerging self-awareness of substance use-related problems based on their responses to the assessment items. Study completers also reported that risk reduction tended to occur precisely because the study was not framed as an intervention. Within this context, the specific aims of the proposed 5-year renewal project are to: 1) identify the covariates of baseline substance abuse and sexual risks (including demographics, social risk measures, peer norms, abuse history, and mental health status) among a sample of 750 heterosexually active, not-in-treatment, club and prescription drug users ages 18 to 39 in Miami, Florida; 2) evaluate, through random assignment, the relative effectiveness of two intervention conditions and a waitlist control in reducing sex risks and drug use, as measured at 3-, 6- and 12-month follow-ups: Arm 1, an interviewer-administered comprehensive health and social risk assessment intervention (CAPI Intervention) similar to the baseline instrument used in the parent grant; Arm 2, an identical self-administered comprehensive assessment intervention (ACASI Intervention); and Arm 3, a waitlist control condition (Control). Outcome measures, including past 90-day counts of unprotected sex acts and days' drug use, will be obtained from brief risk behavior inventories at baseline and follow-ups; and 3) conduct qualitative process evaluation research with 40 participants in each study arm to contextualize the study findings and intervention outcomes. The proposed project is significant, as it responds to the need for brief interventions for a highly vulnerable, high risk population. The self-assessment intervention, if proven efficacious in reducing HIV risk, could be delivered at low cost and broad scale, and might well be adaptable to other high risk groups who are resistant to public health warnings and/or professional intervention.