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

在过去的四分之一个世纪里，在有目的的行为改变方面取得了实质性的进展 降低艾滋病毒/艾滋病风险。然而，具体的人口和社会地理分组仍然存在， 在保持有目的的行为改变方面仍然存在高风险和重大挑战。人中 仍然处于高风险的群体是青少年和年轻人，有色人种以及居住在 转型国家和发展中国家。降低行为风险继续面临的挑战 干预措施包括：a）随着时间的推移，干预效果逐渐减弱; B）改变环境暴露， 在青春期发生的反应;和c）多个会话的资源密集型性质 行为干预，特别是在发展中国家和转型期国家等资源贫乏的环境中。 R 01 MH 069229的竞争性更新将重点关注特别高风险人群（ 在巴哈马政府高中上10年级的非洲裔，巴哈马是一个艾滋病毒血清型国家， 患病率为3%），并提出了一个四细胞，随机，对照试验，旨在解决四个 以上概述的挑战，建立在我们正在进行的研究。在过去的4.5年中， 在资助期间，美国-巴哈马研究小组一直在评估巴哈马对10- 题为“关注加勒比青年”的青少年艾滋病毒预防方案和 名为“加勒比知情父母和儿童一起”的按小时调整的父母监测干预措施 （CImPACT）通过一项随机对照的三细胞试验，涉及1360名6年级青年和1175名 他们的父母从6个月随访开始，延长至24个月 随访3个月，对安全套使用情况、安全套使用意向及相关认知和知识进行调查， 与对照组青年相比，FOYC青年的显著性更高。尽管FOYC的功效， 和36（初步数据） FOYC和对照组青年的实际使用率都很低（例如，24个月时的安全套使用率 36个月时，FOYC青年组分别为30%和40%，对照组分别为20%和25%。因此 巴哈马教育部和美国-巴哈马研究小组试图确定一个 可以向巴哈马十年级学生提供的有效干预措施。在这项研究中， 在本报告中，我们建议：a）从172个10年级FHLE中招募2600名青年（及其父母 巴哈马新普罗维登斯所有7所政府高中两年多的教室; B） 随机分配2400名青少年（及其家长）从160个班级到一个班级， 四种干预条件：1）仅HFLE（无父母干预）; 2）仅BFOOY（无父母干预） 3）BFOOY加ImPACT（提供给父母-青少年二对组合，父母助推器6个月）; 或4）BFOOY加GFI（用六个月的父母加强剂递送给父母-青少年二人组）; c）随机 将七所高中（约12个HFLE班和约200名学生）中的一所分配到“对照学校” （d）评估干预措施的效果， 干预后6、12、18和24个月的整个样本（以及6和12个月的父母）;以及 e）进行分组分析，探讨：㈠在两个关键时刻收到的干预措施的影响 在青春期; ii）作为风险/保护行为纵向试验的一部分的影响;以及iii） 如果随机化单位是班级而不是学校，则干预污染的程度。

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.