HIV/STI Prevention for Adolescents with Substance Use Disorder in Treatment

与没有药物使用障碍的青少年相比，有药物使用障碍的青少年发生艾滋病毒/性传播感染性风险行为的比例明显更高，但在青少年药物使用障碍治疗方案中，并没有定期实施降低艾滋病毒/性传播感染性风险的措施；目前的州政策既不要求诊所提供药物使用治疗的提供者提供减少艾滋病毒/性传播感染的性风险，也不要求提供者提供预防艾滋病毒/性传播感染的工具或培训。为了解决这一紧迫的公共卫生优先事项和缺乏有效的以家庭为基础的性风险降低方案，我们建议：a)制定一项以家庭为基础的性风险降低干预措施，建立门诊诊所的能力，更系统地解决青少年性行为问题，促进青少年更安全的性行为，并减少青少年艾滋病毒/性传播风险行为；b)对干预措施进行试点测试，以检查干预措施在诊所内的可行性和可接受性，并确定为随机对照试验（RCT）做准备的关键研究参数。干预发展过程将使用一种基于社区的参与性研究适应和发展模式，该模式已被PI在其他环境中成功实施。我们将开展形成性工作，指导对患有非sud精神疾病的青少年（13-18岁）进行多家庭群体艾滋病毒/性传播感染性风险降低干预的适应（项目STYLE； R01MH63008; PI: Brown）。这项形成性工作将利用CASALEAP的研究样本，CASALEAP是一项正在进行的nida资助的青少年门诊SUD治疗有效性的自然研究（R01 DA019607; PI: Hogue）。然后，我们将在13-18岁的男性和女性青少年样本（n=60）中对由此产生的新的人工干预（STYLEnS: STYLE and Substance）进行试点测试，这些青少年患有SUD，正在接受心理健康门诊治疗项目的治疗。试验参与者将被随机分配到STYLEnS或注意力控制干预组。参与者将在随机化当天接受全天的小组干预（多家庭，单独的照顾者和单独的青少年），两周后返回青少年/照顾者双人会议，三个月后参加半天的加强小组会议。该试点试验将检查在门诊治疗患有SUD的青少年中实施STYLEnS的可行性、可接受性、关键研究参数和可能的效应大小范围，为随机对照试验做准备。可接受性和可行性将在每次会议之后以及在干预完成后使用过程度量进行评估。我们将评估从基线到干预后3个月的性危险行为结果的变化。在提供SUD治疗的诊所实施降低艾滋病毒/性传播感染风险的干预是一种创新的方法，使SUD治疗提供者能够解决SUD年轻人中较高的艾滋病毒/性传播感染风险，并响应为患有SUD的年轻人提供降低性风险干预服务的需求，这种服务可以很容易地推广到临床环境中。

The rates of HIV/STI sexual risk behaviors among adolescents with substance use disorders (SUD) are significantly higher compared with youth without SUD, yet HIV/STI sexual risk reduction is not regularly implemented within adolescent SUD treatment programs; current state policies neither require providers in clinics delivering substance use treatment to offer HIV/STI sexual risk reduction nor offer providers tools or training for HIV/STI prevention. To address this urgent public health priority and the lack of efficacious family- based HIV/STI sexual risk reduction programs for youth with SUD in treatment, we propose to a) develop a manualized family-based sexual risk reduction intervention that builds the capacity of outpatient clinics to address adolescent sexuality more systematically, to promote youth safer sex practices, and to reduce youth HIV/STI sexual risk behaviors; and b) pilot test the intervention to examine the intervention's feasibility and acceptability within clinics and to determine key research parameters in preparation for a randomized controlled trial (RCT). The intervention development process will use a Community Based Participatory Research model of adaptation and development that has been successfully implemented by the PI in other settings. We will conduct formative work to guide adaptation of a multi-family group HIV/STI sexual risk reduction intervention that has demonstrated efficacy with youth (13-18 years), who have non-SUD psychiatric disorders (Project STYLE; R01MH63008; PI: Brown). This formative work will leverage the research sample of CASALEAP, an ongoing NIDA-funded, naturalistic study of the effectiveness of outpatient SUD treatment for adolescent (R01 DA019607; PI: Hogue). We will then pilot-test the resulting new manualized intervention (STYLEnS: STYLE and Substance) with a sample of male and female adolescents age 13-18 years (n=60) with SUD who are in treatment in mental health outpatient treatment programs. Pilot participants will be randomly assigned to either STYLEnS or an attention control intervention. Participants will receive a full-day group intervention on the day of randomization (multi-family, caregivers alone and adolescents alone), return in two weeks for an individual adolescent/caregiver dyad session, and participate in a half-day booster group session three months later. The pilot test will examine feasibility, acceptability, key study parameters, and range of possible effect sizes of implementing STYLEnS in outpatient clinics treating adolescents with SUD in preparation for a RCT. Acceptability and feasibility will be assessed using process measures following each session as well as after the intervention is completed. We will assess change in sexual risk behavior outcomes from baseline to 3 months post-intervention. Implementing a HIV/STI sexual risk reduction intervention in clinics providing SUD treatment represents an innovative approach to enable SUD treatment providers to address the heightened HIV/STI risk in SUD youth and responds to the need to provide sexual risk reduction intervention services for youth with SUD that can be easily disseminated to clinical settings.