A Computerized family-based youth HIV and drug abuse prevention in Kazakhstan

哈萨克斯坦基于家庭的计算机化青少年艾滋病毒和药物滥用预防

• 批准号: 8534752
• 负责人: Leyla Ismayilova
• 金额: $ 18.23万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8534752
• 关键词: 17 year old; AIDS prevention; Address; Adolescence; Adolescent; Adopted; Adult; Affect; Africa South of the Sahara; Age; Alcohol consumption; Alcohol or Other Drugs use; Area; Asians; C10; Caregivers; Centers for Disease Control and Prevention (U.S.); Central Asia; Client; Collaborations; Communication; Communities; Computers; Country; Development; Drug abuse; Drug usage; Enrollment; Epidemic; Epidemiologic Studies; Ethnic Origin; Family; Family member; Feasibility Studies; Female; Female Adolescents; Frequencies; Funding; Future; Gender; General Population; Growth; HIV; HIV Infections; HIV risk; Health; Health education; Hearing; Heroin; Home environment; Human Resources; Individual; Intervention; Intervention Studies; Kazakhstan; Language; Letters; Life; Male Adolescents; Media Intervention; Monitor; Multimedia; Multiple Partners; Outcome; Parents; Participant; Peer Pressure; Persons; Pharmaceutical Preparations; Phase; Play; Population; Prevention; Prevention program; Preventive Intervention; Public Health; Randomized Controlled Trials; Recruitment Activity; Religion; Research; Research Personnel; Resistance; Risk; Risk Behaviors; Risk Reduction; Risk-Taking; Role; Route; Russia; Safety; Self Efficacy; Services; Sex Behavior; Sexual Partners; Staging; Technology; Testing; USSR; United States National Institutes of Health; Universities; Unsafe Sex; Work; Youth; aged; arm; base; computerized; condoms; cost; cost effective; drug abuse prevention; efficacy trial; evidence base; experience; follow-up; global health; grandparent; high risk; injection drug use; knowledge base; male; operation; outreach; peer; prevent; programs; response; satisfaction; scale up; sex; sex risk; sexually active; skills; substance use prevention; theories; therapy design; tool; trafficking; treatment as usual

DESCRIPTION (provided by applicant): The proposed study is the first randomized controlled trial (RCT) adapting an evidence-based HIV and substance use prevention intervention for most at-risk adolescents and their caregivers (parents or other adult family members) from drug-risk communities in Kazakhstan. Located on major drug trafficking routes, Central Asia and Kazakhstan, in particular, are experiencing one of the fastest growing rates of HIV infection in the world, disproportionately affecting young people. Youth exposed to drugs at home and in the community are particularly at risk. A quarter of at-risk youth in Kazakhstan initiates sexual or substance use risk behaviors between the ages 15-17, making it a crucial stage for prevention. The country's HIV prevention efforts are limited to a knowledge-based approach, which does not equip at-risk youth with skills required to deal with situations of risk exposure. Parents or other caregivers, who represent a significant protective force in a family- oriented culture of Central Asia, are largely excluded from youth prevention efforts in Kazakhstan. In response to PA-09-146, the proposed study will adapt and test the feasibility and estimate the effect size parameters of Kazakhstani Family Together (KFT), a family-based multi-media intervention designed to reduce sexual and drug-related risks for HIV infection among at-risk 15-17 year old females and males living in communities highly affected by heroin trade and use in Almaty, Kazakhstan. To address the dual risk of HIV and substance use, the proposed intervention combines empirically tested skills-based and family involvement approaches and utilizes multi-media computer technology to develop an engaging and potentially cost-effective tool with high fidelity and easy scalability. The US/Kazakhstani investigative team will conduct formative research and will work closely with the Community Collaborative Board to adapt the intervention to the cultural context of at-risk families in Kazakhstan. The KFT intervention will be tested in a pilot RCT with 144 adolescents and 144 of their caregivers. Intervention arm adolescent-caregiver pairs will receive four 45- minute interactive multi-media sessions with avatars customized to participants' ethnicity and gender that will focus on risk reduction self-efficacy, resistance to peer pressure, and caregiver-adolescent communication, support and monitoring. Adolescents from both intervention and control arms will receive the usual care services available for at-risk youth, which includes health education sessions on HIV and drug use delivered by peer educators and outreach workers. To inform a larger efficacy trial, the proposed pilot feasibility study will provide estimates of recruitment, attrition, intervention fidlity, youths' and caregivers' levels of participation and satisfaction with the intervention and preliminary estimates of effects on adolescents' sexual and substance use-related outcomes (current sexual activity, unprotected sex, current use of alcohol or drugs). The study will be led by an investigative team from Columbia University Global Health Research Center of Central Asia (PI: Dr. Ismayilova) in collaboration with local partners providing services to at-risk youth.

描述(申请人提供)：拟议的研究是第一个随机对照试验(RCT)，对哈萨克斯坦毒品风险社区的大多数高危青少年及其照顾者(父母或其他成年家庭成员)采用循证艾滋病毒和药物使用预防干预措施。中亚和哈萨克斯坦位于主要的贩毒路线上，尤其是在世界上艾滋病毒感染率增长最快的地区之一，年轻人受到的影响不成比例。在家里和社区接触毒品的年轻人尤其危险。哈萨克斯坦四分之一的高危青年在15-17岁之间开始性行为或药物使用危险行为，这使其成为预防的关键阶段。该国预防艾滋病毒的努力仅限于以知识为基础的方法，这不能使处于危险中的青年具备处理风险暴露情况所需的技能。在中亚以家庭为导向的文化中，父母或其他照顾者代表着一股重要的保护力量，在哈萨克斯坦的青年预防工作中基本上被排除在外。针对PA-09-146，拟议的研究将调整和测试哈萨克斯坦家庭团结(KFT)的可行性，并估计其效果大小参数，这是一种以家庭为基础的多媒体干预措施，旨在降低生活在哈萨克斯坦阿拉木图受海洛因贸易和使用严重影响的社区的15-17岁高危女性和男性感染艾滋病毒的性风险和毒品相关风险。为了应对艾滋病毒和药物使用的双重风险，拟议的干预措施结合了经过经验检验的基于技能的方法和家庭参与方法，并利用多媒体计算机技术开发了一种具有吸引力和潜在成本效益的工具，具有高保真度和易于扩展的特点。美国/哈萨克斯坦调查小组将进行形成性研究，并将与社区合作委员会密切合作，使干预措施适应哈萨克斯坦高危家庭的文化背景。KFT的干预措施将在 在144名青少年及其照顾者中开展随机对照试验。干预组青少年-照顾者对将接受四个45分钟的互动多媒体会话，使用根据参与者的种族和性别定制的化身，重点是降低风险的自我效能、抵抗同伴压力以及照顾者与青少年的沟通、支持和监测。来自干预和控制部门的青少年将得到为高危青少年提供的常规护理服务，其中包括由同伴教育者和外展工作者提供的关于艾滋病毒和药物使用的健康教育课程。为了向更大规模的疗效试验提供信息，拟议的试点可行性研究将提供对招募、自然减员、干预忠诚度、青少年和照顾者对干预的参与程度和满意度的估计，以及对青少年与性和药物使用相关结果(当前性行为、无保护措施的性行为、目前使用酒精或药物)的影响的初步估计。这项研究将由哥伦比亚大学中亚全球卫生研究中心(PI：Dr.Ismayilova)的一个调查小组领导，并与为高危青年提供服务的当地合作伙伴合作。