A Brief, Clinic-Based, HIV Prevention Program for African American Teen Males

描述（由申请人提供）：疾病控制和预防中心宣布，艾滋病是一个“紧急状态”在美国相对于非洲裔美国人。去性病诊所就诊的青少年男性是非洲裔美国人中一个重要的，但往往被忽视的艾滋病毒感染风险人群。尽管在这一人群中，性传播疾病的获得率（以及随后的感染率）极高，但尚未开发/传播专门用于减少其性传播疾病/艾滋病毒风险行为的有效的基于诊所的干预措施。最近的一项干预试验（由克罗斯比博士进行）证明了一种简短的、以诊所为基础的干预措施的有效性，这种干预措施旨在预防18至29岁的非洲裔美国男性随后获得性传播感染。这项拟议的研究将测试这种干预措施（修改后的形式）在减少非洲裔美国青少年（15至20岁）STI发病率方面的有效性。主要假设是，随机接受干预的青少年在2个月和6个月的随访评估（以及通过医疗记录审查进行的12个月随访）中，与接受注意力等效控制条件的青少年相比，实验室确认的性传播感染的发病率较低。青少年（N = 840）将从位于南部城市地区的公共资助的性病诊所招募。在完成A-CASI评估后，青少年将被评估他们将避孕套应用于阴茎模型的能力，然后被要求捐献尿液样本进行性病检测。将对标本进行C。trachomatis、N. gonorrhoeae和T.使用核酸扩增测定法进行的Vagglutamine。然后通过隐藏分配技术实现随机化。青少年将随机立即接受：1）由非专业健康顾问提供的简短（60分钟）基于理论的一对一互动干预，或2）注意力等效控制条件。将在入组后2个月和入组后6个月重复评估组合。将在入组后12个月进行医疗记录审查，以比较青少年随机分组之间的临床报告发病率。如果这一青少年人群中的性传播感染发病率能够像以前对18至29岁非洲裔美国男性的研究中发现的那样大幅降低（相对差异百分比= 36.7），那么非洲裔美国青少年男性的公共卫生意义将大大有助于纠正非洲裔美国青少年男性所经历的艾滋病毒/性病的种族差异。推而广之，我们建议他们的伴侣（通常是非洲裔美国青少年女性）也将受益。由于我们的计划是为了便于实施而设计的，因此传播和翻译问题的数量将大大减少，从而大大促进了将研究转化为实践的过程。公共卫生相关性：拟议的疗效试验测试了一种弥合研究与实践之间差距的创新方法。通过向参加性病诊所的非洲裔美国青少年男性提供一个简短的、以诊所为基础的艾滋病毒/性病预防计划，这项研究将首次证明，青少年的性风险行为可以在没有过多时间和资源的情况下减少。鉴于疾病预防控制中心最近宣布艾滋病对非裔美国人来说是一种“紧急状态”，对非裔美国人青少年男性的关注也是相当及时的。

DESCRIPTION (provided by applicant): The Centers for Disease Control and Prevention has declared that AIDS is a "state of emergency" in the US relative to African Americans. Teen males attending STD clinics are one important, yet often neglected, population of African Americans at risk of HIV acquisition. Despite extremely high rates of STD acquisition (and subsequent infection) among this population, effective clinic-based interventions specifically designed to reduce their sexual risk behavior for STD/HIV have not been developed/disseminated. A recent intervention trial (conducted by Dr. Crosby) demonstrated the efficacy of a brief, clinic-based, intervention designed to prevent subsequent STI acquisition among African American males 18 to 29 years of age. The proposed study will test the efficacy this intervention (in modified form) to reduce STI incidence among African American teen (15 to 20 years old). The primary hypothesis is that teens randomized to receive the intervention will have a lower incidence rate of laboratory-confirmed STIs at 2 and 6-month follow-up assessments (as well as 12-month follow-up conducted by a medical records review) compared to those receiving an attention-equivalent control condition. Teens (N = 840) will be recruited from a publicly-funded STD clinic located in an urban area of the South. After completing an A-CASI assessment, teens will be rated on their ability to apply condoms to a penile model and then asked to donate a urine specimen for STI testing. Specimens will be tested for C. trachomatis, N. gonorrhoeae, and T. Vaginalis using nucleic acid amplification assays. Randomization will then be achieved by a concealment of allocation technique. Teens will be randomized to immediately receive: 1) a brief (60 minute) theory-based, one-on-one, interactive intervention delivered by a lay health advisor or 2) an attention equivalent control condition. The assessment battery will be repeated 2 months subsequent to enrollment and again 6 months after enrollment. A medical records review will be conducted 12 months after enrollment to compare clinic reported incidence rates between the randomized groups of teens. If incidence of STIs in this population of teens can be decreased as substantially as was found in the previous study of 18 to 29 year-old African American males (percent relative difference = 36.7), the public health significance for African American teen males will substantially contribute to rectify the racial disparity in HIV/STD experienced by African American teen males. By extension, we suggest that their partners (typically African American teen females) will also benefit. Because our program is designed for ease of implementation, the number of dissemination and translation issues will be greatly minimized thereby greatly facilitating the process of translating research into practice. PUBLIC HEALTH RELEVANCE: The proposed efficacy trial tests an innovative method of bridging the gap between research and practice. By providing a brief, clinic-based, HIV/STD prevention program to African American teen males attending an STD clinic, the study will be the first to demonstrate that teen's sexual risk behavior can be reduced without excessive time and resources. The focus on African American teen males is also quite timely given the recent declaration by CDC that AIDS is a "state of emergency" for African Americans.