Comparative Effectiveness of Web-based vs. Traditional Adolescent HIV Prevention

基于网络与传统青少年艾滋病毒预防的效果比较

• 批准号: 7942921
• 负责人: Lisa A. Marsch
• 金额: $ 49.56万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7942921
• 关键词: AIDS prevention; Achievement; Address; Adolescent; Adoption; Age; Alcohol or Other Drugs use; Area; Attitude; Behavior; Cause of Death; Communicable Diseases; Communication; Communities; Complex; Data; Diffusion; Disease; Drug usage; Economics; Educational Technology; Effectiveness; Effectiveness of Interventions; Ensure; Epidemic; Evidence based intervention; Evidence based practice; Future; HIV; HIV Infections; Health; Health Personnel; Hepatitis; Impulsivity; Individual; Internet; Intervention; Knowledge; Mediation; Mental Health; Modeling; Online Systems; Outcome; Outpatients; Patient Self-Report; Persons; Population; Predisposition; Prevention; Preventive; Preventive Intervention; Procedures; Relative (related person); Reporting; Research; Resources; Risk; Risk Behaviors; Schools; Science; Self Efficacy; Self-control as a personality trait; Sexual Partners; Sexually Transmitted Diseases; Substance abuse problem; System; Technology; Time; Training; Transcend; Youth; adolescent drug use; adolescent substance abuse; base; behavioral health; care systems; comparative effectiveness; computerized; condoms; cost; cost effectiveness; disorder later incidence prevention; disorder prevention; effectiveness research; evidence base; high risk; improved; interest; non-drug; peer; post intervention; prevent; programs; psychosocial; public health relevance; safer sex; sex; skill acquisition; skills; skills training; substance abuse treatment; tool; transmission process; treatment program; trend; web-based social networking

DESCRIPTION (provided by applicant): This application addresses broad challenge Area (05): Comparative Effectiveness Research (CER) and specific Challenge Topic, 05-DA-102*: Treatment of Substance Abuse and Related Health Consequences Using Web-Based Technologies. Youth are frequently at the center of the HIV epidemic, and HIV has been referred to as a "youth-driven disease" worldwide. In the U.S., 40% of all new HIV infections occur in persons under age 25 years, and HIV is the 6th leading cause of death among adolescents. Youth who use drugs are at particularly high risk for HIV, as well as other infectious diseases with similar transmission dynamics, such as hepatitis and Sexually Transmitted Infections (STIs), relative to their non-drug using peers. Several HIV prevention interventions have been shown to be effective with adolescents, but they are infrequently provided to youth, even in formal systems of care such as adolescent substance abuse treatment programs. Additionally, virtually no adolescent substance abuse treatment programs offer evidence-based interventions targeting STIs or hepatitis. Evidence-based prevention interventions are expensive to implement and strain available resources, given the limited staffing and high caseloads at the average substance abuse treatment program. Even if evidence-based HIV prevention interventions are initiated by staff in community treatment programs, it may be difficult to ensure their fidelity. Thus, the limited compatibility of research-based interventions with treatment agency realities may present numerous operational barriers to the transfer of evidence-based practice in community-based settings. We previously developed an interactive, customizable, web-based program focused on the prevention of HIV, STIs and hepatitis for youth that incorporates effective components of both prevention science and educational technologies that promote mastery of key skills and information. This tool allows a complex intervention to be delivered with high fidelity and at low cost, without increasing demands on staff time or training needs. We demonstrated that this web-based tool, when provided as an adjunct to an educator- delivered HIV and infectious disease prevention intervention, enhanced desired outcomes (e.g., increased accurate HIV/disease prevention knowledge, increased intentions to reduce risk behavior) relative to the educator-delivered prevention intervention when provided alone. However, given that so few adolescent substance abuse treatment programs have the resources to offer traditionally-delivered, evidence-based HIV, hepatitis, and STI prevention interventions, understanding the independent effectiveness of this self-directed, web-delivered intervention (as a stand-alone intervention) is a clinically important question. In the presently proposed trial, we will examine the comparative effectiveness and cost-effectiveness of the web-based HIV, hepatitis and STI prevention intervention when offered to youth in outpatient, community- based substance abuse treatment when directly compared to a traditional (educator-delivered) HIV and infectious disease prevention intervention. We will assess the comparative effectiveness of these interventions by primarily examining changes from pre- to post-intervention in accurate HIV/disease prevention knowledge, intentions to engage in safer sex, and HIV risk behavior. Additionally, we will examine the extent to which the interventions impact relevant skills acquisition (e.g., communication skills, negotiation skills and condom use skills), attitudes toward safer sex, and self-reported substance use. We will also examine the acceptability of each intervention (e.g., by asking youth to rate how useful, interesting, etc. each intervention was). We also plan to evaluate youth at both 1 and 3 month post-intervention to examine the durability of effects (including any differential durability of effects across intervention conditions). We will also perform an economic analysis of the web-based program in community-based, adolescent substance abuse treatment programs. We will estimate the incremental cost-effectiveness ratio of this web- delivered intervention relative to the educator-delivered intervention from a societal perspective (presented as costs per HIV infections prevented, estimated from changes in HIV risk behavior). We will also estimate cost- effectiveness from the substance abuse treatment program's perspective and payer's perspective to better understand the factors impacting the adoption of this intervention at the local level. Because of the considerable cost constraints within treatment programs, demonstration of effectiveness is not sufficient for implementation of evidence-based practice. Rather, demonstration of cost-effectiveness is necessary. A technology-based approach to HIV prevention creates new opportunities and outlets for intervention efforts that are not tied to traditional strategies. This web-based tool, and similar technology-based interventions, if found effective and cost-effective, could substantially advance the substance abuse treatment system by markedly improving the availability and quality of HIV prevention interventions delivered to individuals in such treatment settings. Importantly, this web-based intervention can transcend geographic boundaries, thus enabling its use, in future applications, in a wide variety of settings where HIV prevention interventions for youth are typically limited (e.g., schools, health care providers' offices, online social networks). This web-based system can also be expanded to address other issues, such as evidence-based skills training (e.g., self-control training), substance abuse psychosocial treatment/relapse prevention and mental health issues. Thus, our proposed project has the potential to greatly increase the pace and achievement of research examining the effectiveness of technology-based interventions targeting behavioral health. Public Health Relevance Statement The computerized intervention we propose to evaluate in this project, if found effective and cost-effective, could substantially advance the adolescent substance abuse treatment system by markedly improving the availability and quality of HIV (and infectious disease) prevention interventions delivered to youth in such settings. Further, this intervention is web-based, thus enabling its use in a wide variety of settings where HIV prevention interventions for youth are typically limited (e.g., schools, health care providers' offices, online social networks). The proposed project may generate clinically and economically meaningful data regarding the use of technology in promoting new models of delivery of science-based HIV prevention for adolescents, with the potential to have a substantive impact in changing the trajectory of the HIV epidemic among youth.

描述（由申请人提供）：本申请解决了广泛的挑战领域 (05)：比较有效性研究 (CER) 和具体挑战主题 05-DA-102*：使用基于网络的技术治疗药物滥用和相关健康后果。青少年往往是艾滋病毒流行的中心，艾滋病毒在世界范围内被称为“青少年驱动的疾病”。在美国，所有新发艾滋病毒感染者中有 40% 发生在 25 岁以下的人群中，艾滋病毒是青少年第六大死因。与不吸毒的同龄人相比，吸毒的青少年感染艾滋病毒以及具有类似传播动力的其他传染病的风险特别高，例如肝炎和性传播感染（STI）。一些艾滋病毒预防干预措施已被证明对青少年有效，但很少向青少年提供这些干预措施，即使是在青少年药物滥用治疗计划等正规护理系统中也是如此。此外，几乎没有青少年药物滥用治疗计划提供针对性传播感染或肝炎的循证干预措施。鉴于一般药物滥用治疗项目的人员配备有限且案件量很大，基于证据的预防干预措施实施起来成本高昂，而且可用资源紧张。即使基于证据的艾滋病毒预防干预措施是由社区治疗项目的工作人员发起的，也可能很难确保他们的忠诚度。因此，基于研究的干预措施与治疗机构现实的兼容性有限，可能会给社区环境中循证实践的转移带来许多操作障碍。我们之前开发了一个交互式、可定制、基于网络的计划，重点是预防青少年艾滋病毒、性传播感染和肝炎，该计划结合了预防科学和教育技术的有效组成部分，促进了关键技能和信息的掌握。该工具允许以高保真度和低成本提供复杂的干预，而不会增加对员工时间或培训需求的需求。我们证明，相对于单独提供教育者提供的预防干预措施，这种基于网络的工具作为教育者提供的艾滋病毒和传染病预防干预措施的辅助手段提供时，可以增强预期结果（例如，增加准确的艾滋病毒/疾病预防知识，增加减少危险行为的意图）。然而，鉴于很少有青少年药物滥用治疗项目有资源提供传统上提供的、基于证据的艾滋病毒、肝炎和性传播感染预防干预措施，了解这种自我导向的、网络提供的干预措施（作为独立干预措施）的独立有效性是一个临床上重要的问题。在目前提出的试验中，我们将研究向年轻人提供基于网络的艾滋病毒、肝炎和性传播感染预防干预措施与传统（教育者提供的）艾滋病毒和传染病预防干预措施的直接比较，以及基于网络的艾滋病毒、肝炎和性传播感染预防干预措施在门诊、社区药物滥用治疗中的相对有效性和成本效益。我们将通过主要检查干预前和干预后在准确的艾滋病毒/疾病预防知识、安全性行为意愿和艾滋病毒危险行为方面的变化来评估这些干预措施的相对有效性。此外，我们将研究干预措施对相关技能获取（例如沟通技能、谈判技能和安全套使用技能）、对安全性行为的态度以及自我报告的药物使用的影响程度。我们还将检查每项干预措施的可接受性（例如，通过要求青少年评价每项干预措施的有用性、趣味性等）。我们还计划在干预后 1 个月和 3 个月对青少年进行评估，以检查效果的持久性（包括干预条件下效果的持久性差异）。我们还将对基于社区的青少年药物滥用治疗计划中的网络计划进行经济分析。我们将从社会角度估计这种网络提供的干预措施相对于教育者提供的干预措施的增量成本效益比（以预防艾滋病毒感染的每次成本表示，根据艾滋病毒危险行为的变化进行估计）。我们还将从药物滥用治疗计划的角度和付款人的角度估计成本效益，以更好地了解影响地方一级采用该干预措施的因素。由于治疗计划中相当大的成本限制，有效性的证明不足以实施循证实践。相反，证明成本效益是必要的。基于技术的艾滋病毒预防方法为不依赖于传统战略的干预工作创造了新的机会和途径。如果发现这种基于网络的工具和类似的基于技术的干预措施有效且具有成本效益，则可以通过显着提高向此类治疗环境中的个人提供的艾滋病毒预防干预措施的可用性和质量，从而大大推进药物滥用治疗系统。重要的是，这种基于网络的干预措施可以超越地理界限，从而使其能够在未来的应用中在针对青少年的艾滋病毒预防干预措施通常受到限制的各种环境中使用（例如学校、医疗保健提供者办公室、在线社交网络）。这个基于网络的系统还可以扩展到解决其他问题，例如基于证据的技能培训（例如自我控制培训）、药物滥用心理社会治疗/复发预防和心理健康问题。因此，我们提出的项目有可能大大提高研究的速度和成果，以检验针对行为健康的基于技术的干预措施的有效性。公共卫生相关性声明 我们建议在该项目中评估的计算机化干预措施，如果被认为有效且具有成本效益，可以通过显着提高向此类环境中的青少年提供的艾滋病毒（和传染病）预防干预措施的可用性和质量，从而大大推进青少年药物滥用治疗系统。此外，这种干预措施是基于网络的，因此能够在针对青少年的艾滋病毒预防干预措施通常有限的各种环境中使用（例如学校、医疗保健提供者办公室、在线社交网络）。拟议的项目可能会产生具有临床和经济意义的数据，涉及利用技术促进为青少年提供基于科学的艾滋病毒预防的新模式，并有可能对改变青少年中艾滋病毒流行的轨迹产生实质性影响。