Preventing Rural Thai Methamphetamine Abuse and HIV by Community Mobilization

描述(由申请人提供)：R01 DA14702-01修订后的竞争性延续申请继续我们的行为干预，以降低泰国北部与非注射甲基苯丙胺相关的青少年和年轻成人HIV性行为风险。在我们资助的前五年，我们描述了MA使用的变化和HIV感染的性风险。2004年，我们启动了研究程序，2006年5月完成了登记(n=987)；数据收集于2007年7月结束。我们在试验中有出色的招募、参与和保留(90%)，现在我们将重点转移到偏远的农村地区。民族志显示，MA和其他非注射毒品的使用在农村青年中普遍存在，并与艾滋病毒风险有关。我们寻求通过促进由受影响社区制定并与受影响社区一起制定的社区一级结构性干预措施来防止MA滥用和艾滋病毒风险。我们的具体目标是：(1)遵循连接到保护(C2P)的方法，促进社区动员、社区能力建设和社区参与，以促成结构性变化，从而降低艾滋病毒感染的MA和其他非注射药物使用风险。(2)在25个村的5个社区群中进行为期3年的C2P整群随机试验，并与附近5个社区群中为HIV VCT转诊提供转诊的25个村进行比较，比较其在MA和减少性风险方面的效果。在C2P动员之前和之后的两个15个月间隔期间，将在队列中评估艾滋病毒和性传播感染的发生率、药物和性风险以及耻辱。最后，(3)在实验社区内，使用定性的过程评估数据来评估C2P干预产生行为改变的组成部分。目标社区的人种志将决定当地动员、能力建设和参与的优先事项。我们将从50个选定的社区中随机挑选40名14-29岁的社区居民参加一项队列研究(n=2000)，以系统地确定风险。我们将对与降低社区一级MA风险相关的干预措施组成部分的过程和人种学数据进行统计评估。这项拟议的研究从理论上成功地借鉴了美国的做法，解决了泰国青少年在社区层面所经历的问题，并在国际环境中推广了这一模式。该项目提出了一种社区一级的行为干预措施，以减少泰国北部青少年和年轻成人与非注射甲基苯丙胺有关的艾滋病毒性行为风险。我们将使用一种社区动员、社区能力建设和社区参与的方法来推动结构性改革，从而降低MA和其他非注射毒品使用风险，使艾滋病毒感染在美国被用于应对社区确定的青少年毒品问题。

DESCRIPTION (provided by applicant): This revised competing continuation application of R01 DA14702-01 continues our behavioral interventions to reduce adolescent and young adult HIV sexual risks associated with non-injection methamphetamine use in northern Thailand. During the first five years of our grant, we characterized variation in MA use and sexual risks for HIV acquisition. In 2004, we started study procedures and enrollment was completed (n=987) in May 2006; data collection ends in July 2007. We have had excellent recruitment, participation and retention (>90%) in the trial and we now shift our focus to remote, rural areas. Ethnography shows MA and other non-injection drug use is pervasive among rural youth and associated with HIV risk. We seek to prevent MA abuse and HIV risk by promoting community-level structural interventions developed by and with the affected communities. Our specific aims are: (1) to follow the Connect to Protect (C2P) approach to promote community mobilization, community capacity building, and community involvement to forge structural changes leading to decreased MA and other non-injection drug use risks for HIV acquisition. (2) to conduct a cluster-randomized trial of C2P over 3 years in 5 community clusters of 25 villages and compare its efficacy in MA and sexual risk reduction compared to 25 villages in 5 nearby community clusters that offer referrals for HIV VCT referrals. HIV and STI incidence, drug and sex risks, and stigma will be assessed in cohorts before and for two 15 month intervals after C2P mobilization. Finally, (3) within experimental communities, to evaluate components of the C2P intervention that generate behavior change using qualitative process evaluation data. Ethnography in targeted communities will determine local priorities for mobilization, capacity building and involvement. We will recruit 40 randomly selected community dwellers aged 14-29 years of age from each of 50 selected communities to participate in a cohort study (n=2000) to systematically determine risk. We will conduct a statistical evaluation of process and ethnographic data on components of the interventions associated with reductions in community-level MA risk. The proposed study takes a successful theoretically grounded approach from the USA to confronting problems experienced by youth at the community level in Thailand, and it promotes this model in an international setting. This project proposes a community-level behavioral intervention to reduce adolescent and young adult HIV sexual risks associated with non-injection methamphetamine use in northern Thailand. We will use an approach to community mobilization, community capacity building, and community involvement to forge structural changes leading to decreased MA and other non-injection drug use risks for HIV acquisition that has been used in the USA to respond to community-identified youth drug problems.