Adapting MST to Address Transmission Risk Behaviors in HIV+ Young People

说明（由申请人提供）：青少年，特别是少数民族青年，是艾滋病毒新感染人数增长最快的群体（国立卫生研究院，1997年）。许多艾滋病毒阳性青少年从事高风险性行为和其他传播风险行为，包括使用药物和不遵守药物治疗。寻找全面的干预措施，有效地解决艾滋病毒阳性青少年的性行为和其他传播风险行为，是一个重要的公共卫生目标（Coates, 1998）。研究表明，传播风险行为是多重决定的，驱动因素发生在个人、照顾者、同伴、学校和社区生态层面。因此，有效的干预措施需要全面针对这些系统中的相关驱动因素。本研究的第一个目的是采用一种经验验证的干预措施，即多系统治疗（MST; Henggeler et al., 1998）来解决艾滋病毒阳性青少年的性风险行为。MST是一种基于生态的干预措施，最初旨在通过针对各级青少年生态的司机来解决严重的青少年犯罪问题。拟议的适应将纳入先前成功的MST适应，用于药物滥用/依赖青年和药物非依从青年。这项研究的第二个目的是对50名年龄在11-17岁的艾滋病毒阳性青年进行一项试点研究，这些青年在南卡罗来纳州的两家艾滋病诊所之一接受治疗，并从事一种或多种传播风险行为。超过90%的年轻人将是非裔美国人。青少年将被随机分配到实验（MST-HIV）治疗条件或比较干预，该干预补充了常规治疗（TAU）和单次动机访谈（Ml）。招募后9个月将收集主要结果措施，并将评估危险性行为、酒精和药物使用以及对艾滋病毒药物治疗方案的依从性。如果结果支持MST-HIV的有效性，将提议进行更大规模的试验，以进一步检查成本和临床效果。艾滋病毒是一个严重的公共卫生问题，特别是对少数民族青年而言。为了减少艾滋病毒的传播，干预措施必须全面针对传播风险行为的多因素驱动因素。MST对严重问题行为具有临床和成本效益，有效克服了服务获取障碍，具有文化竞争力，在大多数州都可以使用。因此，MST有潜力提供一个优秀的平台，在此平台上为艾滋病毒阳性青年建立和提供有效的适应。

DESCRIPTION (provided by applicant): Adolescents, and especially minority youth, are the fastest growing population for new HIV infection National Institutes of Health, 1997). Many HIV+ adolescents engage in high risk sexual behaviors and other transmission risk behaviors including substance use and medication non-adherence. Finding comprehensive interventions that effectively address sexual and other transmission risk behaviors in HIV+ adolescents is an important public health goal (Coates, 1998). Research indicates that transmission risk behaviors are multi- determined, with drivers occurring at individual, caregiver, peer, school, and community ecological levels. Thus, effective interventions will need to comprehensively target relevant drivers across these systems. The first aim of the present study is to adapt an empirically validated intervention, Multisystemic Therapy (MST; Henggeler et al., 1998) to address sexual risk behaviors by HIV+ adolescents. MST is an ecologically-based intervention originally designed to address serious juvenile delinquency by targeting drivers across all levels of youths' ecologies. The proposed adaptation will incorporate prior successful adaptations of MST for use with substance abusing/dependent youth and medication non-adherent youth. The second aim of this study s to conduct a pilot study with 50 HIV+ youths ages 11-17 years who receive treatment at one of two AIDS clinics in South Carolina and who engage in one or more transmission risk behaviors. Over 90% of the youth will be African American. Youth will be randomly assigned to the experimental (MST-HIV) treatment condition or to a comparison intervention that supplements treatment as usual (TAU) with a single session of Motivational Interviewing (Ml). Principal outcome measures will be collected through 9-months post- recruitment and will assess risky sexual behaviors, alcohol and drug use, and adherence to HIV medication regimens. If results support the efficacy of MST-HIV, a larger trial will be proposed to further examine cost and clinical effectiveness. HIV represents a serious public health concern, especially for minority youth. To reduce the spread of HIV, interventions must comprehensively target the multivariate drivers of transmission risk behaviors. MST is clinically and cost effective with serious problem behaviors, effectively overcomes services access barriers, is culturally competent, and available in most States. Thus, MST has the potential to provide an excellent platform on which to build and deliver effective adaptations for HIV+ youths.