A Computerized family-based youth HIV and drug abuse prevention in Kazakhstan

描述（由申请人提供）：拟议的研究是第一个随机对照试验（RCT），针对哈萨克斯坦毒品风险社区的大多数高危青少年及其照顾者（父母或其他成年家庭成员）采用基于证据的艾滋病毒和药物使用预防干预措施。中亚和哈萨克斯坦位于主要的毒品贩运路线上，是世界上艾滋病毒感染率增长最快的地区之一，对年轻人的影响尤为严重。在家庭和社区接触毒品的青少年尤其危险。哈萨克斯坦四分之一的高危青年在15-17岁之间开始性行为或药物使用风险行为，这是预防的关键阶段。该国的艾滋病毒预防工作仅限于以知识为基础的方法，这种方法没有使有风险的青年掌握处理风险暴露情况所需的技能。在中亚以家庭为导向的文化中，父母或其他照顾者是一种重要的保护力量，但在哈萨克斯坦，他们基本上被排除在青少年预防工作之外。为响应pa - 9-146，拟议的研究将调整和测试哈萨克斯坦家庭一起（KFT）的可行性，并估计效应大小参数。KFT是一项基于家庭的多媒体干预，旨在降低生活在哈萨克斯坦阿拉木图海洛因交易和使用严重影响社区的15-17岁高危男女感染艾滋病毒的性和毒品相关风险。为了解决艾滋病毒和药物使用的双重风险，建议的干预措施结合了经验验证的基于技能和家庭参与的方法，并利用多媒体计算机技术开发出一种具有高保真度和易于扩展的具有吸引力和潜在成本效益的工具。美国/哈萨克斯坦调查小组将进行形成性研究，并将与社区合作委员会密切合作，使干预措施适应哈萨克斯坦处境危险家庭的文化背景。KFT干预将在一个

DESCRIPTION (provided by applicant): The proposed study is the first randomized controlled trial (RCT) adapting an evidence-based HIV and substance use prevention intervention for most at-risk adolescents and their caregivers (parents or other adult family members) from drug-risk communities in Kazakhstan. Located on major drug trafficking routes, Central Asia and Kazakhstan, in particular, are experiencing one of the fastest growing rates of HIV infection in the world, disproportionately affecting young people. Youth exposed to drugs at home and in the community are particularly at risk. A quarter of at-risk youth in Kazakhstan initiates sexual or substance use risk behaviors between the ages 15-17, making it a crucial stage for prevention. The country's HIV prevention efforts are limited to a knowledge-based approach, which does not equip at-risk youth with skills required to deal with situations of risk exposure. Parents or other caregivers, who represent a significant protective force in a family- oriented culture of Central Asia, are largely excluded from youth prevention efforts in Kazakhstan. In response to PA-09-146, the proposed study will adapt and test the feasibility and estimate the effect size parameters of Kazakhstani Family Together (KFT), a family-based multi-media intervention designed to reduce sexual and drug-related risks for HIV infection among at-risk 15-17 year old females and males living in communities highly affected by heroin trade and use in Almaty, Kazakhstan. To address the dual risk of HIV and substance use, the proposed intervention combines empirically tested skills-based and family involvement approaches and utilizes multi-media computer technology to develop an engaging and potentially cost-effective tool with high fidelity and easy scalability. The US/Kazakhstani investigative team will conduct formative research and will work closely with the Community Collaborative Board to adapt the intervention to the cultural context of at-risk families in Kazakhstan. The KFT intervention will be tested in a pilot RCT with 144 adolescents and 144 of their caregivers. Intervention arm adolescent-caregiver pairs will receive four 45- minute interactive multi-media sessions with avatars customized to participants' ethnicity and gender that will focus on risk reduction self-efficacy, resistance to peer pressure, and caregiver-adolescent communication, support and monitoring. Adolescents from both intervention and control arms will receive the usual care services available for at-risk youth, which includes health education sessions on HIV and drug use delivered by peer educators and outreach workers. To inform a larger efficacy trial, the proposed pilot feasibility study will provide estimates of recruitment, attrition, intervention fidlity, youths' and caregivers' levels of participation and satisfaction with the intervention and preliminary estimates of effects on adolescents' sexual and substance use-related outcomes (current sexual activity, unprotected sex, current use of alcohol or drugs). The study will be led by an investigative team from Columbia University Global Health Research Center of Central Asia (PI: Dr. Ismayilova) in collaboration with local partners providing services to at-risk youth.