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

描述(由申请人提供)：大量涉及毒品的青少年进入少年司法系统时，面临着性传播感染(STI)、衣原体和淋病的风险，这些可治疗的、通常是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，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健康干预措施需要关于所有违法者(不仅仅是被监禁者)中的性传播感染如何与药物使用和危险行为相关的数据。此外，对社区中的青少年罪犯实施的减少性传播感染/艾滋病毒风险干预措施很少。因此，有必要加深我们对青少年中处于少年司法系统“前端”的吸毒和性危险行为的了解，开发新的筛查方法，以便在少年司法程序的早期识别感染，并向更广泛的这一群体提供更有效的预防和治疗服务。这笔赠款建议在希尔斯伯勒县(FL)青少年评估中心(JAC)实施STI评估和尿液筛查(衣原体和淋病)方案；分析药物使用、性危险行为和STI感染率之间的关系；确定与STI相关的服务需求和障碍，以扩大针对这一服务不足的高危人群的STI检测和服务。未来的计划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，并在受控临床试验中开发、试点和实施性传播感染风险降低计划。来自摄入量评估和性传播感染尿液测试的数据将从连续进入JAC的900名符合条件的犯罪青年中收集(分层得出450名女性(一个重要但未被研究的亚群)。组织数据将来自少年司法和服务提供者记录、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。将从希尔斯伯勒县卫生局为STI阳性参与者收集STI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一项目和未来的项目上与研究团队合作。这项研究有四个目标：目标1：评估高危青少年罪犯(即活跃的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，并将他们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，以及提供这些服务的组织和个人障碍。目的3：确定进入少年司法系统的少年犯的性病(衣原体和淋病)和自我报告的艾滋病毒流行率。目的：测定性传播感染阳性青年返乡就医的比例，分析影响提供和接受治疗的相关因素。

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.