Evidence-based multi level risk reduction for Bahamian mid-adolescents

描述（由申请人提供）：在过去的四分之一世纪中，在实现有目的的行为改变以降低艾滋病毒/艾滋病风险方面取得了实质性进展。然而，特定的人口和社会地理亚群体仍然处于高风险之中，在维持有目的的行为改变方面仍然存在重大挑战。在那些仍然处于高风险的群体中，有青少年和年轻人、有色人种以及居住在转型期和发展中国家的个人。减少行为风险干预措施继续面临的挑战包括：a)随着时间的推移，干预效果逐渐减弱；B)发生在青春期的环境暴露及其反应的变化；c)多期行为干预的资源密集性，特别是在资源贫乏的环境中，如发展中国家和转型国家。R01MH069229的竞争性更新将重点关注特别高风险人群（在巴哈马，一个艾滋病血清患病率为3%的国家，在公立高中就读10年级的非洲裔青年），并提出一个四细胞，随机对照试验，旨在解决上述四个挑战，建立在我们正在进行的研究的基础上。在我们目前的资助期内，在过去的4年半时间里，美国-巴哈马研究小组通过一项随机、对照的三细胞试验，评估了巴哈马对名为“关注加勒比青年”（FOYC）的10期青少年艾滋病毒预防计划的适应情况，以及名为“加勒比知情父母与儿童在一起”（CImPACT）的1小时父母监测干预措施的适应情况。该试验涉及1360名六年级青少年和1175名家长。从6个月的随访开始到24个月的随访，FOYC青年的安全套使用、安全套使用意图和相关认知和知识显著高于对照组青年。尽管FOYC有效，但FOYC和对照组的实际使用率和36（初步数据）都很低（例如，FOYC青年在24个月和36个月时的安全套使用率分别为30%和40%，对照组为20%和25%）。因此，巴哈马教育部和美国-巴哈马研究小组寻求确定一种有效的干预措施，可以提供给巴哈马的10年级学生。在本报告所述的研究中，我们建议：a)在两年多的时间里，从巴哈马新普罗维登斯所有7所公立高中的172个10年级FHLE教室中招募2600名青少年（及其父母）；b)在课堂层面，从160个班级中随机分配2400名青少年（及其父母）到四种干预条件中的一种：1)只有HFLE（没有父母干预）；2)仅BFOOY（无家长干预）；3) BFOOY + ImPACT（提供给父母-青少年组，附有6个月的父母助推器）；或4)BFOOY + GFI（提供给父母-青少年组，并附有6个月的父母增强剂）；c)将7所高中（约12个HFLE班级，约200名学生）中的一所随机分配到“对照学校”条件下，以探索学校内可能存在的班级间污染；d)评估干预后6个月、12个月、18个月和24个月对整个样本的干预效果（以及6个月和12个月对家长的干预效果）；e)进行分组分析，以探讨：i)在青春期的两个关键时刻接受干预的影响；Ii)参与纵向试验对风险/保护行为的影响；如果随机化的单位是班级而不是学校，干预污染的程度。

DESCRIPTION (provided by applicant): Over the last quarter century, substantial progress has been made in effecting purposeful behavioral change to reduce HIV/AIDS risk. Nevertheless, specific demographic and socio-geographic sub-groups remain at high risk and substantial challenges in maintaining purposeful behavioral change persist. Among those groups remaining at high risk are adolescents and young adults, persons of color, and individuals residing in transitional and developing countries. Challenges that have continued to confront behavioral risk reduction interventions include: a) waning intervention effects over time; b) changing environmental exposures and responses thereto that occur during adolescence; and c) the resource intensive nature of multiple session behavioral interventions especially in resource poor settings such as developing and transitional countries. This competitive renewal of R01MH069229 will focus on a particularly high risk population (youth of African descent attending Grade 10 in government high schools in The Bahamas, a nation with an HIV sero- prevalence of 3%) and proposes a four-cell, randomized, controlled trial designed to address each of the four challenges outlined above, building upon our ongoing research. During the past 4.5 years in our current funding period, the US-Bahamian research team has been evaluating the Bahamian adaptation of a 10- session adolescent HIV prevention program entitled "Focus on Youth in The Caribbean" (FOYC) and the 1- hour adapted parental monitoring intervention entitled "Caribbean Informed Parents and Children Together" (CImPACT) through a randomized, controlled three-celled trial involving 1360 Grade 6 youth and 1175 of their parents. Beginning at the 6 months follow-up and extending through 24 months follow-up, condom-use, condom-use intention, and relevant perceptions and knowledge were significantly higher among FOYC youth compared to control youth. Despite the efficacy of FOYC, the and 36 (preliminary data) actual rates among both FOYC and control youth are concerningly low (e.g. condom-use rates at 24 months and 36 months was 30% and 40% among FOYC youth and 20% and 25% among controls). Therefore, the Department of Education of The Bahamas and the US-Bahamian Research Team seek to identify an effective intervention that can be delivered to Grade 10 students in The Bahamas. In the research described in this submission, we propose to: a) Recruit 2600 youth (and their parents) from 172 Grade 10 FHLE classrooms over two years from all 7 government high schools in New Providence, The Bahamas; b) Randomly assign at the level of the classroom 2400 youth (and their parents) from 160 classes to one of four intervention conditions: 1) HFLE only (no parent intervention); 2) BFOOY only (no parent intervention); 3) BFOOY plus ImPACT (delivered to parent-youth dyads with a six month parent booster); or 4) BFOOY plus GFI (delivered to parent-youth dyads with a six month parent booster); c) Randomly assign one of the seven high schools (with ~12 HFLE classes and ~200 students) to a "control school" condition to explore possible class-to-class contamination within schools; d) Assess intervention effects on the entire sample at 6, 12, 18 and 24 months post-intervention (and among parents at 6 and 12 months); and e) Conduct sub-group analyses to explore: i) the impact of interventions received at two critical junctures during adolescence; ii) the effect of being part of a longitudinal trial on risk/protective behaviors; and iii) the extent of intervention contamination if the unit of randomization is the class rather than the school. PUBLIC HEALTH RELEVANCE: The proposed research will allow us to determine the best way to intervene with youth as they enter into the age of greatest HIV risk whether they have or have not had previous exposure to HIV risk reduction efforts. The project will help us to elucidate the role that parents may be able to assume in collaboration with a formal, school-based HIV prevention program to help protect their youth.. This research is both timely and of great global importance addressing many of the key research questions confronting AIDS researchers throughout the world. 1