Assessing the Feasibility of Economic Approaches to Prevention of Substance Abuse among Adolescents

项目摘要 青少年酗酒和吸毒(ADU)是撒哈拉以南非洲(SSA)的一个重大公共卫生挑战。 在SSA，约41.6%的青少年报告至少使用了一种精神活性物质，其中酒精是最多的 常用药物。乌干达是南部非洲最贫穷的国家之一，人均贫穷率位居第二。 SSA的酒精消费量(15.1升纯酒精与6.2升纯酒精的地区平均水平)及以上 三分之一的乌干达青少年一生中饮酒，2250万人目前饮酒，超过 50%的人断断续续地酗酒。这些估计在该国的渔业中达到了更大的规模 村庄--艾滋病毒易受感染的关键人群--在那里，ADU是规范的。一些研究已经评估了ADU在 AYLHIV，然而AYLHIV患ADU的风险更高，ADU阻碍了抗逆转录病毒治疗(ART)的坚持， 保留护理和病毒抑制。一些研究考察了ADU的风险和复原力因素 但针对ADU的干预措施很少在SSA进行测试。只有10项ADU干预措施进行了评估 在SSA，只有几个人成功了。大多数是在学校环境中实施的，这 可能会将辍学率高的渔业社区的青少年排除在外。更重要的是，没有一个人 有针对性的风险因素，如贫困和精神健康，这些因素在艾滋病病毒及其家人中非常猖獗， 削弱AYLHIV的应对技能和资源，并与ADU风险增加有关 青少年。以家庭为基础的经济赋权(费用)干预有可能防止成人 通过减少贫困及其相关的精神健康影响，并支持AYLHIV和 他们的家庭资源，以克服与艾滋病毒有关的挑战。在缺乏证据的情况下 在低收入地区，如乌干达，为预防艾滋病患者ADU而进行的文化定制干预，这项研究 建议：目标1a。检查200例AYLHIV(15岁--)样本中ADU的患病率和后果 24)在乌干达西南部渔业社区的六(6)家艾滋病毒诊所就诊。ADU将被测量 使用自我报告和生物学数据(即尿液)。目标1b。使用混合方法方法，确定多个 AYLHIV中与ADU相关的水平(个人、人际、社区和结构性)因素。目标2： 使用样本的一个子集，探索费用干预对ADU的可行性和短期影响 AYLHIV。我们的干预重点是高危环境(即捕鱼)中的大龄青少年和年轻人 社区)阐明AYLHIV中ADU的上下文相关风险和复原力因素 正在经历社会转型。此外，我们创新性地针对最常见的风险因素 ADU(即贫困和心理健康问题)，包括提供青年发展的费用 储蓄账户、金融知识课程和ADU降低风险课程。我们的发现将为设计提供依据 研究以家庭为基础的经济赋权干预对ADU的长期影响 在AYLHIV中。

PROJECT ABSTRACT Adolescent alcohol and drug use (ADU) is a significant public health challenge in sub-Saharan Africa (SSA). About 41.6% of adolescents in SSA reported using at least one psychoactive agent, with alcohol being the most commonly used drug. Uganda, one of the poorest countries in SSA, has the second highest rate of per capita alcohol consumption in SSA (15.1 liters of pure alcohol vs regional average of 6.2 liters of pure alcohol) and over one third of Ugandan adolescents have used alcohol in their lifetime, 22.5 million are current drinkers, and over 50% engage in heavy episodic drinking. These estimates reach even greater magnitudes in the country’s fishing villages – a key HIV vulnerable population- where ADU is normative. A few studies have assessed ADU among AYLHIV, yet AYLHIV are at higher risk for ADU, and ADU impedes adherence to anti-retroviral therapy (ART), retention in care, and viral suppression. Several studies have examined the risk and resilience factors for ADU but few interventions targeting ADU have been tested in SSA. Only 10 ADU interventions have been evaluated in SSA and only a few have been successful. The majority have been implemented in school settings, which may exclude adolescents in fishing communities that have high rates of school dropout. Moreover, none has targeted risk factors such as poverty and mental health, which are rampant among AYLHIV and their families, undermine AYLHIV’s coping skills and resources, and have been associated with increased risk for ADU among adolescents. Family-based economic empowerment (FEE) interventions have the potential to prevent ADU among AYLHIV by reducing poverty and its associated mental health impacts, and also bolstering AYLHIV and their families’ resources to overcome the challenges associated with HIV. Given the lack of evidence-based culturally tailored interventions to prevent ADU in AYLHIV in low-income settings such as Uganda, this study proposes to: Aim 1a. Examine the prevalence and consequences of ADU in a sample of 200 AYLHIV (ages 15- 24) seen at six (6) HIV clinics located in the fishing communities of southwestern Uganda. ADU will be measured using self-report and biological data (i.e. urine). Aim 1b. Using a mixed methods approach, identify the multi- level (individual, interpersonal, community and structural) factors associated with ADU among AYLHIV. Aim 2: Using a subset of the sample, explore the feasibility and short-term effects of a FEE intervention on ADU among AYLHIV. Our intervention focuses on older adolescents and young adults in a high-risk environment (i.e. fishing communities) to elucidate the contextually relevant risk and resilience factors for ADU among AYLHIV undergoing social transitions. Additionally we innovatively target the most commonly occurring risk factors for ADU (i.e. poverty and mental health problems) through the FEE that includes provision of youth development savings accounts, financial literacy sessions and ADU risk reduction sessions. Our findings will inform the design of an R01 grant to examine the long-term effects of a family-based economic empowerment intervention on ADU among AYLHIV.