Targeting HIV Risk Behaviors in Juvenile Drug Court-Involved Youth

针对涉及青少年毒品法庭的青少年的艾滋病毒危险行为

• 批准号: 7688641
• 负责人: Elizabeth J Letourneau
• 金额: $ 48.55万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-25 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7688641
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adolescent; Adopted; Adoption; Alcohol or Other Drugs use; Behavior; Behavioral; Centers for Disease Control and Prevention (U.S.); Clinical Trials; Collaborations; Communities; Community Services; Cost Effectiveness Analysis; Counseling; Criminal Justice; Drug Courts; Drug abuse; Drug usage; Educational Intervention; Effectiveness; Effectiveness of Interventions; Enrollment; Evidence based practice; Evidence based treatment; Family; Follow-Up Studies; HIV; HIV Infections; HIV Seropositivity; Health Services Research; Human immunodeficiency virus test; Individual; Institution; Intervention; Knowledge; Label; Measures; Methods; Minority; Outcome; Pharmaceutical Preparations; Population; Preparation; Preventive Intervention; Protocols documentation; Randomized; Randomized Controlled Clinical Trials; Recruitment Activity; Reporting; Research; Research Design; Research Personnel; Risk; Risk Behaviors; Risk Reduction; Services; Sexually Transmitted Diseases; Societies; Staging; System; Testing; United States Public Health Service; Work; Youth; active method; adolescent substance abuse; base; community based treatment; contingency management; court; criminal behavior; critical period; design; effective intervention; emerging adulthood; evidence base; follow-up; health disparity; high risk; high risk sexual behavior; intervention effect; juvenile delinquent; offender; peer; protocol development; public health relevance; sex risk; therapy development; treatment effect

DESCRIPTION (provided by applicant): The overriding purpose of this study is to develop and test an intervention for reducing substance use and risky sexual behaviors among youth involved in juvenile drug court. Juvenile drug court provides an excellent setting in which to pursue the key study objectives by providing access to a well identified high risk population. Second, in addition to frequent judicial oversight, juvenile drug courts include several features that can enhance intervention effectiveness, sustainability, and potential for adoption. In addition, the fact that all juvenile drug courts have community-based treatment components and that such courts have been disseminated nationwide suggests the possibility of eventual widespread adoption if the proposed intervention is effective. The proposed intervention integrates evidence-based protocols for contingency management (CM) for substance abusing youth and family engagement strategies, with an evidence-informed family systems intervention for sexual risk originally developed to address substance use and sexual risk behaviors in HIV+ youth. These three interventions will be integrated into an efficient intervention that, if effective, can be amenable to adoption by juvenile drug courts. Following protocol development and beta testing, 160 drug court youth and their families will be randomized to the experimental intervention condition (HIV Risk Reduction or "HRR") versus Drug Court with Community Services (DC) conditions. Key outcomes will be assessed through 12-months post-baseline using a multi-method approach that will include assessment of substance use, risky sexual behaviors, criminal behavior, and participation in HIV counseling and testing services. Specific aims include: 1: Adapt existing intervention and training protocols into a single, efficient HRR intervention, beta test this HHR protocol with four youth in juvenile drug court and their families, and revise treatment and research protocols accordingly; 2: Conduct a randomized trial with 160 youth in juvenile drug court and their families to examine youth-level intervention effects (i.e., on substance use, sexual risk behavior, HIV counseling and testing, delinquent behavior) in comparison to DC through 12- months post referral and assess intervention fidelity. 3. If results suggest a positive HRR treatment effect, revise the intervention and training protocols in preparation for an effectiveness study and extended follow-up study. Importantly, the proposed study will (1) consider the multiple levels of influence on juvenile drug use, criminal justice involvement, and HIV risk behaviors, (2) integrate a drug abuse and HIV prevention intervention for youth in the criminal justice system with drug-related offenses, (3) address health disparities by targeting a primarily minority population of youth, and (4) increase referrals to HIV testing and counseling of drug court-involved youth. This study is designed to reduce HIV risk by addressing the potent interaction of drug use and risky sexual behaviors in drug court youth with evidence-based treatment components to maximize the likelihood of reversing these youths' adverse behavioral trajectories. PUBLIC HEALTH RELEVANCE: The proposed study is designed to gain knowledge about effective interventions for reducing HIV risk in a high risk population. Reducing HIV risk by effectively targeting substance use and risky sexual behaviors and by locating even a small number of HIV-positive youth could favorably impact society at multiple levels (individual, family, peer, community, fiscal).

描述(由申请人提供)：这项研究的首要目的是开发和测试一种干预措施，以减少青少年毒品法庭中的药物使用和危险的性行为。少年毒品法庭提供了一个很好的环境，通过提供接触明确识别的高危人群来实现关键的研究目标。第二，除了频繁的司法监督外，少年毒品法庭还包括几个可以增强干预有效性、可持续性和采用潜力的特点。此外，所有少年毒品法庭都有以社区为基础的治疗部分，而且这种法庭已在全国范围内传播，这一事实表明，如果拟议的干预措施有效，最终有可能得到广泛采用。拟议的干预措施结合了针对滥用药物青少年的应急管理(CM)和家庭参与战略的循证协议，以及最初为解决艾滋病毒+青少年的药物使用和性风险行为而开发的循证家庭系统干预措施。这三种干预措施将被整合为一种有效的干预措施，如果有效，可以被少年毒品法庭采用。在制定方案和进行贝塔测试后，160名毒品法庭青少年及其家人将被随机分配到试验性干预条件(艾滋病毒风险降低或“HRR”)与毒品法庭社区服务(DC)条件下。关键结果将通过基线后12个月使用多种方法进行评估，其中将包括评估药物使用、危险性行为、犯罪行为以及参与艾滋病毒咨询和检测服务。具体目标包括：1：将现有的干预和培训方案调整为单一、有效的人力资源干预方案，在青少年毒品法庭的四名青少年及其家人中测试这一HHR方案，并相应修改治疗和研究方案；2：对青少年毒品法庭的160名青少年及其家人进行随机试验，通过12个月的转诊后检查青少年层面的干预效果(即药物使用、性危险行为、艾滋病毒咨询和检测、犯罪行为)与DC的效果比较，并评估干预的忠诚度。3.如果结果显示有积极的HRR治疗效果，修改干预和培训方案，为有效性研究和扩展的后续研究做准备。重要的是，拟议的研究将(1)考虑对青少年吸毒、刑事司法参与和艾滋病毒危险行为的多重影响，(2)将针对青少年的药物滥用和艾滋病毒预防干预纳入刑事司法系统与与毒品有关的犯罪行为，(3)通过主要针对少数族裔青年来解决健康差距，以及(4)增加对涉及毒品法庭的青少年进行艾滋病毒检测和咨询的转介。这项研究旨在通过解决毒品法庭青年中吸毒和危险性行为与循证治疗成分的有效相互作用来降低艾滋病毒风险，以最大限度地逆转这些青年的不良行为轨迹。 公共卫生相关性：拟议的研究旨在了解在高危人群中降低艾滋病毒风险的有效干预措施。通过有效地针对药物使用和危险的性行为，甚至通过定位少量艾滋病毒阳性青年来降低艾滋病毒风险，可以在多个层面(个人、家庭、同伴、社区、财政)对社会产生有利影响。