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

描述（由申请人提供）：拟议的研究是第一项随机对照试验（RCT），适用于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）的循证艾滋病毒和药物使用预防干预。地处主要贩毒路线的中亚和哈萨克斯坦，尤其是世界上艾滋病毒感染率增长最快的地区之一，对青年人的影响尤为严重。在家中和社区接触毒品的青年面临的风险尤其大。哈萨克斯坦四分之一的高危青年在15至17岁之间开始性行为或使用药物的风险行为，使其成为预防的关键阶段。该国的艾滋病毒预防工作仅限于基于知识的方法，这并没有使有风险的青年掌握处理风险情况所需的技能。在中亚以家庭为导向的文化中，父母或其他照顾者是一股重要的保护力量，但在哈萨克斯坦，他们基本上被排除在青年预防工作之外。 根据PA-09-146，拟议的研究将调整和测试哈萨克斯坦家庭团聚（KFT）的可行性，并估计其效应量参数，KFT是一种以家庭为基础的多媒体干预措施，旨在减少生活在哈萨克斯坦阿拉木图受海洛因贸易和使用影响严重的社区的15-17岁高危女性和男性感染艾滋病毒的性风险和毒品相关风险。为了解决艾滋病毒和物质使用的双重风险，建议的干预措施结合经验测试的技能为基础的和家庭参与的方法，并利用多媒体计算机技术开发一个具有高保真度和易于扩展的参与和潜在的成本效益的工具。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高危家庭的文化背景。KFT的干预措施将在一个 对144名青少年和144名他们的照顾者进行了试点RCT。干预组的父母-照顾者对将接受四次45分钟的互动多媒体会议，并根据参与者的种族和性别定制头像，重点是降低风险的自我效能感，抵抗同伴压力，以及青少年与青少年的沟通，支持和监测。来自干预和控制两个分支的青少年将获得风险青少年通常可获得的护理服务，其中包括由同伴教育者和外联工作者提供的关于艾滋病毒和吸毒的健康教育课程。为了为更大规模的疗效试验提供信息，拟议的试点可行性研究将提供招募、自然减员、干预fidlity、青少年和照顾者参与水平和对干预的满意度的估计，以及对青少年性和物质使用相关结果（当前性活动、无保护性行为、当前酒精或药物使用）影响的初步估计。这项研究将由哥伦比亚大学中亚全球健康研究中心的一个调查小组（PI：Ismayilova博士）与当地合作伙伴合作，为高危青年提供服务。

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.