A Self-Assessment Intervention for Young Adult Polydrug Users at Risk for HIV

描述（由申请人提供）：吸毒是城市俱乐部场景的规范，MDMA（摇头丸）和可卡因是最普遍的“俱乐部”毒品。本申请提议继续提供的父母补助金不仅记录了高比率的精神健康问题和广泛的逮捕和虐待历史，而且在以异性恋为主的年轻成人样本中，未确诊的艾滋病毒感染率也出人意料地高，令人震惊。这项父母资助计划已进入第五个年头，是一项为期18个月的纵向自然历史研究，研究对象是600名俱乐部和使用处方药的年轻人。该研究的一项重要发现是，综合健康和社会风险评估在多大程度上促使参与者减少其药物使用和性风险行为。超过70%的参与者在基线后的第一次随访评估中大幅减少了药物使用。定性研究表明，参与者将基线评估的强干预效应归因于：1)友好的、非评判性的同辈现场工作人员；2)全面、详细的评估；3)基于他们对评估项目的反应，他们对药物使用相关问题的自我意识正在增强。完成研究的人还报告说，风险的降低往往恰恰是因为研究没有被框定为一种干预。在此背景下，拟议的5年更新项目的具体目标是：1)确定佛罗里达州迈阿密市750名年龄在18至39岁的异性恋活跃者、未接受治疗者、俱乐部和处方药使用者的基线药物滥用和性风险协变量（包括人口统计学、社会风险措施、同伴规范、滥用史和精神健康状况）；2)通过随机分配，评估两种干预条件和候补名单控制在降低性风险和药物使用方面的相对有效性，在3个月、6个月和12个月的随访中测量：第1组，访谈者管理的综合健康和社会风险评估干预（CAPI干预），类似于父母资助中使用的基线工具；第2组，相同的自我管理综合评估干预（ACASI干预）；Arm 3是一个等待列表控制条件（control）。结果测量，包括过去90天无保护的性行为计数和用药天数，将从基线和随访时的简短风险行为清单中获得；3)进行定性过程评价研究，每个研究组各有40名参与者，将研究结果和干预结果背景化。拟议的项目意义重大，因为它满足了对高度脆弱、高风险人群进行简短干预的需要。如果证明自我评估干预在减少艾滋病毒风险方面是有效的，就可以以低成本和广泛的规模提供，并且很可能适用于对公共卫生警告和/或专业干预不感兴趣的其他高风险群体。

DESCRIPTION (provided by applicant): Drug use is normative in urban club scenes, with MDMA (ecstasy) and cocaine being the most prevalent "club" drugs. The parent grant which this application proposes to continue has documented not only high rates of mental health problems and extensive arrest and abuse histories, but also unexpectedly and alarmingly high rates of undiagnosed HIV infection among a predominately heterosexual young adult sample. The parent grant, now in its fifth year, is an 18-month longitudinal natural history study of 600 club and prescription drug using young adults. A key finding from that study is the extent to which the comprehensive health and social risk assessments induced participants to reduce their substance use and sexual risk behaviors. Over 70% of participants substantially reduced their substance use at the first follow-up assessment after baseline. Qualitative research with study completers showed that participants attributed the strong intervention effect of the baseline assessment to: 1) the friendly, non-judgmental field staff of age-peers; 2) the thorough and detailed assessments; and 3) an emerging self-awareness of substance use-related problems based on their responses to the assessment items. Study completers also reported that risk reduction tended to occur precisely because the study was not framed as an intervention. Within this context, the specific aims of the proposed 5-year renewal project are to: 1) identify the covariates of baseline substance abuse and sexual risks (including demographics, social risk measures, peer norms, abuse history, and mental health status) among a sample of 750 heterosexually active, not-in-treatment, club and prescription drug users ages 18 to 39 in Miami, Florida; 2) evaluate, through random assignment, the relative effectiveness of two intervention conditions and a waitlist control in reducing sex risks and drug use, as measured at 3-, 6- and 12-month follow-ups: Arm 1, an interviewer-administered comprehensive health and social risk assessment intervention (CAPI Intervention) similar to the baseline instrument used in the parent grant; Arm 2, an identical self-administered comprehensive assessment intervention (ACASI Intervention); and Arm 3, a waitlist control condition (Control). Outcome measures, including past 90-day counts of unprotected sex acts and days' drug use, will be obtained from brief risk behavior inventories at baseline and follow-ups; and 3) conduct qualitative process evaluation research with 40 participants in each study arm to contextualize the study findings and intervention outcomes. The proposed project is significant, as it responds to the need for brief interventions for a highly vulnerable, high risk population. The self-assessment intervention, if proven efficacious in reducing HIV risk, could be delivered at low cost and broad scale, and might well be adaptable to other high risk groups who are resistant to public health warnings and/or professional intervention. PUBLIC HEALTH RELEVANCE: Club drug users report high levels of sexual risk behaviors as well as other problems related to substance use. The proposed study is a randomized clinical trial to evaluate the efficacy of a substance use and sexual risk reduction intervention among heterosexually active men and women in the club culture. The self-assessment intervention, if proven efficacious in reducing HIV risk, could be delivered at low cost and broad scale, and might well be adaptable to other high risk groups who are resistant to public health warnings and/or professional intervention.