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

与未患药物使用障碍的青少年相比，患有药物使用障碍的青少年的艾滋病毒/性传播感染性风险行为发生率显著较高，但在青少年药物使用障碍治疗方案中，并未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提供药物使用治疗的诊所提供者提供降低艾滋病毒/性传播感染性风险的措施，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，以及缺乏有效的以家庭为基础的艾滋病毒/性病性风险降低计划，为青少年治疗的SUD，我们建议a）制定一个手动的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，以更系统地解决青少年性行为，促进青少年安全性行为，并减少青少年艾滋病毒/性病性风险行为;和B）对干预进行初步测试，以检查干预在诊所内的可行性和可接受性，并确定关键的研究参数，为随机对照试验（RCT）做准备。干预措施的制定过程将采用以社区为基础的适应和发展研究模式，该模式已由PI在其他环境中成功实施。我们将开展形成性工作，以指导多家庭群体艾滋病毒/性传播感染性风险降低干预措施的适应，该干预措施已证明对患有非SUD精神疾病的青年（13-18岁）有效（项目STYLE; R 01 MH 63008; PI：Brown）。这项形成性工作将利用CASALEAP的研究样本，CASALEAP是一项正在进行的由NIDA资助的关于青少年门诊SUD治疗有效性的自然主义研究（R 01 DA 019607; PI：Hogue）。然后，我们将试点测试所产生的新的手动干预（STYLEnS：风格和物质）与男性和女性青少年的样本年龄13-18岁（n=60）与SUD谁是在心理健康门诊治疗计划的治疗。试点参与者将被随机分配到STYLEnS或注意力控制干预。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），两周后返回进行单独的青少年/照顾者二元会议，并在三个月后参加为期半天的加强组会议。试点测试将检查可行性，可接受性，关键研究参数，以及在门诊诊所实施STYLEnS治疗SUD青少年的可能效应量范围，为RCT做准备。可接受性和可行性将在每次会话后以及干预完成后使用过程测量进行评估。我们将评估从基线到干预后3个月性风险行为结果的变化。在提供SUD治疗的诊所实施减少艾滋病毒/性传播感染风险的干预措施是一种创新方法，使SUD治疗提供者能够解决SUD青年中艾滋病毒/性传播感染风险增加的问题，并满足为SUD青年提供减少性风险干预服务的需要，这些服务可以很容易地传播到临床环境。

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.