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

在有物质使用障碍(SUD)的青少年中，HIV/STI性危险行为的发生率明显高于没有SUD的青少年，但减少HIV/STI性风险并没有在青少年SUD治疗计划中定期实施；目前的国家政策既没有要求提供物质使用治疗的诊所的提供者提供HIV/STI性风险降低，也没有为提供者提供预防艾滋病毒/STI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基于家庭的艾滋病毒/性传播性风险降低计划，我们建议：a)开发基于家庭的手动减少性风险干预措施，以建设门诊诊所更系统地解决青少年性行为的能力，促进青少年更安全的性行为，并减少青少年艾滋病毒/性传播感染的性危险行为；以及b)对干预措施进行试点测试，以检查干预措施的可行性和临床可接受性，并确定关键研究参数，为随机对照试验(RCT)做准备。干预发展进程将采用适应和发展的以社区为基础的参与性研究模式，该模式已由国际和平研究所在其他环境中成功实施。我们将开展形成性工作，指导多家庭小组艾滋病毒/性传播感染减少性风险干预措施的适应，该干预措施已在患有非SUD精神障碍的青少年(13-18岁)中显示出有效性(Project Style；R01MH63008；PI：Brown)。这项形成工作将利用CASALEAP的研究样本，CASALEAP是一项由NIDA资助的关于青少年门诊SUD治疗有效性的自然主义持续研究(R01 DA019607；PI：Hogue)。然后，我们将对正在心理健康门诊治疗计划中接受治疗的13-18岁(n=60)患有SUD的男性和女性青少年样本进行试行测试新的手动干预(STYLEnS：Style and Substance)。飞行员参与者将被随机分配到STYLEns或注意力控制干预中。参与者将在随机化当天接受全天的团体干预(多个家庭、单独的照顾者和青少年)，在两周后返回参加个人青少年/照顾者二人组会议，并在三个月后参加为期半天的强化小组会议。试点试验将检验在门诊诊所实施STYLEns的可行性、可接受性、关键研究参数和可能的效果大小范围，为随机对照试验做准备，治疗患有SUD的青少年。将在每届会议之后以及干预完成后使用进程措施评估可接受性和可行性。我们将评估性危险行为结果从基线到干预后3个月的变化。在提供SUD治疗的诊所实施艾滋病毒/性传播感染降低性风险干预措施是一种创新的方法，使SUD治疗提供者能够解决SUD青少年中艾滋病毒/性传播感染风险增加的问题，并回应为患有SUD的青少年提供可轻松传播到临床环境的减少性风险干预服务的需要。

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.