Adapting MST to Address Transmission Risk Behaviors in HIV+ Young People

说明(申请人提供)：青少年，特别是少数族裔青年，是新感染艾滋病毒的人口中增长最快的群体(美国国立卫生研究院，1997年)。许多HIV+青少年从事高危性行为和其他传播危险行为，包括使用药物和不遵守药物治疗。寻找有效解决艾滋病毒+青少年性行为和其他传播危险行为的综合干预措施是一个重要的公共卫生目标(Coates，1998)。研究表明，传播风险行为是多因素决定的，驱动因素发生在个人、照顾者、同伴、学校和社区生态层面。因此，有效的干预措施需要全面瞄准这些系统的相关驱动因素。本研究的第一个目的是采用一种经验性验证的干预措施--多系统疗法(MST；Henggler et al.，1998)来处理HIV+青少年的性危险行为。MST是一种基于生态的干预措施，最初旨在通过针对所有级别的青少年生态环境的司机来解决严重的青少年犯罪问题。拟议的适应化修改将纳入MST先前的成功改编，供滥用药物/依赖药物的青少年和未服药的青少年使用。这项研究的第二个目的是S对50名11-17岁的艾滋病毒阳性青少年进行试点研究，他们在南卡罗来纳州两家艾滋病诊所中的一家接受治疗，并从事一种或多种传播危险行为。超过90%的年轻人将是非裔美国人。青年将被随机分配到试验性(MST-HIV)治疗条件下，或接受对照干预，以单次动机访谈(ML)补充照常治疗(TAU)。主要结果指标将通过招募后9个月收集，并将评估危险的性行为、酒精和药物使用以及对艾滋病毒药物治疗方案的遵守情况。如果结果支持MST-HIV的疗效，将提出一项更大规模的试验，以进一步检查成本和临床效果。艾滋病毒是一个严重的公共卫生问题，特别是对少数民族青年来说。为了减少艾滋病毒的传播，干预措施必须全面针对传播危险行为的多变量驱动因素。MST对严重的问题行为具有临床和成本效益，有效地克服了服务获得障碍，具有文化能力，并在大多数国家可用。因此，MST有可能提供一个极好的平台，在此平台上为艾滋病毒+青年建立和提供有效的适应。

DESCRIPTION (provided by applicant): Adolescents, and especially minority youth, are the fastest growing population for new HIV infection National Institutes of Health, 1997). Many HIV+ adolescents engage in high risk sexual behaviors and other transmission risk behaviors including substance use and medication non-adherence. Finding comprehensive interventions that effectively address sexual and other transmission risk behaviors in HIV+ adolescents is an important public health goal (Coates, 1998). Research indicates that transmission risk behaviors are multi- determined, with drivers occurring at individual, caregiver, peer, school, and community ecological levels. Thus, effective interventions will need to comprehensively target relevant drivers across these systems. The first aim of the present study is to adapt an empirically validated intervention, Multisystemic Therapy (MST; Henggeler et al., 1998) to address sexual risk behaviors by HIV+ adolescents. MST is an ecologically-based intervention originally designed to address serious juvenile delinquency by targeting drivers across all levels of youths' ecologies. The proposed adaptation will incorporate prior successful adaptations of MST for use with substance abusing/dependent youth and medication non-adherent youth. The second aim of this study s to conduct a pilot study with 50 HIV+ youths ages 11-17 years who receive treatment at one of two AIDS clinics in South Carolina and who engage in one or more transmission risk behaviors. Over 90% of the youth will be African American. Youth will be randomly assigned to the experimental (MST-HIV) treatment condition or to a comparison intervention that supplements treatment as usual (TAU) with a single session of Motivational Interviewing (Ml). Principal outcome measures will be collected through 9-months post- recruitment and will assess risky sexual behaviors, alcohol and drug use, and adherence to HIV medication regimens. If results support the efficacy of MST-HIV, a larger trial will be proposed to further examine cost and clinical effectiveness. HIV represents a serious public health concern, especially for minority youth. To reduce the spread of HIV, interventions must comprehensively target the multivariate drivers of transmission risk behaviors. MST is clinically and cost effective with serious problem behaviors, effectively overcomes services access barriers, is culturally competent, and available in most States. Thus, MST has the potential to provide an excellent platform on which to build and deliver effective adaptations for HIV+ youths.