STI/HIV Risk, Services, and Drug Use For Young Arrestees

描述（由申请人提供）：大量吸毒的青少年进入少年司法系统，面临性传播感染（STIs）衣原体和淋病的风险，这些可治疗且通常无症状的细菌感染会增加艾滋病毒的风险。然而，目前对少年犯的性传播感染监测是以症状为基础的，而且通常仅限于教养设施（尽管大多数少年犯没有被监禁），导致许多未被发现的病例增加了公共卫生风险。设计和扩大更有效的性传播感染卫生干预措施，需要有关所有罪犯（而不仅仅是被监禁者）的性传播感染与吸毒和危险行为之间关系的数据。此外，社区对青少年罪犯实施的减少性传播感染/艾滋病毒风险的干预措施很少。因此，有必要进一步了解青少年司法系统“前端”的吸毒和性风险行为，开发新的筛查方法，在少年司法过程中早期识别感染，并为更广泛的人群提供更有效的预防和治疗服务。这笔拨款提议在希尔斯堡县（FL）青少年评估中心（JAC）实施性传播感染评估和尿液筛查（衣原体和淋病）方案；分析吸毒、性危险行为与性传播感染的关系；确定与性传播感染相关的服务需求，以及为这一服务不足的高危人群扩大性传播感染检测和服务的障碍。未来计划的研究将进一步探索犯罪青少年的性传播感染相关服务需求，并在对照临床试验中制定、试点和实施降低性传播感染风险的方案。将从连续进入JAC的900名符合条件的犯罪青年样本中收集摄入评估和性传播感染尿液测试的数据(分层产生450名女性（一个重要但研究不足的亚人群）。组织数据将取自少年司法和服务提供者的记录、关于感染和保健服务地点的地理编码数据以及40个工作人员访谈。将从希尔斯堡县卫生部门收集性传播感染阳性参与者的性传播感染治疗和重新检测的后续数据。JAC和州/县卫生官员致力于在这个和未来的项目上与研究小组合作。目标1：评估高危少年犯（即活跃吸毒者和有吸毒风险的人）的性传播感染/艾滋病毒风险概况，并将其与低风险罪犯进行比较。目标2：确定少年犯的性传播感染和艾滋病毒预防服务需求，以及组织和个人提供这些服务的障碍。目的3：确定进入少年司法系统的少年犯中衣原体和淋病的感染率和自我报告的艾滋病毒感染率。目标4：确定返回接受治疗的性传播感染阳性青年的百分比，并分析与提供和接受治疗有关的因素。

DESCRIPTION (provided by applicant): Large numbers of drug-involved adolescents enter the juvenile justice system at risk for the sexually transmitted infections (STIs) chlamydia and gonorrhea, treatable and often asymptomatic bacterial infections that increase HIV risk. However, current STI surveillance for juvenile offenders is symptom-based and typically limited to correctional facilities (although most juvenile offenders are not incarcerated), resulting in many undetected cases that increase public health risk. Designing and expanding more effective STI health interventions require data on how STI infection among all delinquents (not just those incarcerated) is related to drug use and risk behaviors. Moreover, few STI/HIV risk reduction interventions have been implemented for adolescent offenders in the community. Thus, there is a need to further our understanding of drug use and sex risk behaviors among youth at the "front end" of the juvenile justice system, to develop new screening methods that identify infections early in the juvenile justice process, and to provide more effective prevention and treatment services to a broader segment of this population. This grant proposes to implement an STI assessment and urine screening (for chlamydia and gonorrhea) protocol in the Hillsborough County (FL) Juvenile Assessment Center (JAC); analyze relations among drug use, sex risk behaviors and STI infection rates; and identify STI-related service needs and impediments to expanding STI testing and services for this underserved high-risk population. Future planned research will further explore the STI-related service needs of delinquent youth, and develop, pilot, and implement an STI risk reduction program in a controlled clinical trial. Data from an Intake Assessment and STI urine tests will be collected from a sample of 900 eligible delinquent youth consecutively admitted to the JAC (stratified to yield 450 females (an important but understudied subpopulation). Organizational data will be drawn from juvenile justice and service provider records, geocoded data on infections and health service locations, and 40 staff interviews. Follow-up data on STI treatment and retesting will be collected from the Hillsborough County Health Department for STI-positive participants. JAC and State/County health officials are committed to collaborating with the research team on this and future projects. There are four study aims: AIM 1: To assess STI/HIV risk profiles in high-risk juvenile offenders (i.e. active drug users and those at risk for drug use) and compare them to low-risk offenders. AIM 2: To identify STI and HIV prevention service needs among juvenile offenders and the organizational and individual barriers to delivering these services. AIM 3: To determine STI (chlamydia and gonorrhea) and self-reported HIV prevalence rates among juvenile offenders entering the juvenile justice system. AIM 4: To determine the percentage of STI-positive youth who return for medical treatment, and analyze the factors associated with provision and receipt of treatment.