Multimedia HIV/STI Prevention for Drug-Involved Female Offenders

描述(由申请人提供)：拟议的研究响应RFA-DA-08-007，该研究呼吁进行研究，以“在刑事司法环境中开发和测试综合的药物使用和艾滋病毒危险行为预防干预措施”。尽管在社区监督下涉及毒品的女性罪犯数量庞大且不断增加，而且越来越多的证据表明她们感染艾滋病毒/性传播感染的风险增加，但针对这一人群的循证艾滋病毒预防干预措施仍然存在严重差距。这项拟议的研究旨在通过进行一项随机对照试验(RCT)来解决这一关键差距，该试验将严格测试多媒体版本的4节、特定性别的综合药物使用和艾滋病毒/性传播感染预防干预(多媒体沃思)在增加安全套使用率和降低性传播感染(STI)发病率方面的有效性，在纽约市的一个大型替代监禁(ATI)缓刑计划中，420名涉及毒品的女性罪犯与相同干预的非媒体版本(传统沃思)和非性别特定的NIDA标准艾滋病毒预防控制条件(NIDA控制)进行比较。参与者将在基线、即刻后测试(IPT)、6个月和干预后12个月的随访时进行重复测量。与非多媒体干预相比，多媒体干预被发现在促进减少艾滋病毒风险和减少物质使用方面是有效的。此外，多媒体干预有望提高执行的保真度以及传播的速度、规模和质量。传统的价值干预是由这项研究的调查团队开发的，作为一种针对低收入、城市女性罪犯的群体、综合药物使用和艾滋病毒预防干预措施，旨在解决亲密伴侣暴力(IPV)和其他性别特有的艾滋病毒风险因素。沃思在两个不同的随机对照试验中进行了测试，发现在涉及毒品的女性囚犯和接受药物治疗的女性中增加避孕套的使用是有效的。多媒体价值包含与传统价值相同的内容，但使用多媒体互动工具以及根据文化定制的动画和视频增强功能，旨在通过最大限度地增加个人学习机会和反馈，同时优化小组形式，为减少艾滋病毒风险建立积极的同行规范和社会支持，从而加强干预措施的交付。这一严格的随机对照研究将推进科学，扩大多媒体艾滋病毒预防研究的范围，同时旨在弥合刑事司法系统艾滋病毒预防工作中的一个关键差距。 公共卫生相关性：拟议的研究针对在社区监督下涉及毒品的女性罪犯中艾滋病毒和其他性传播感染对公共健康的重大威胁。拟议的随机对照试验将严格测试针对性别的多媒体艾滋病毒预防干预措施在增加避孕套使用和减少性传播感染发生率方面的效果。这种创新的多媒体方法可以增强标准化的以群体为基础的艾滋病毒预防干预措施的影响和交付，并有望提高在负担过重的刑事司法环境中传播以证据为基础的艾滋病毒预防干预措施的能力、质量和速度。

DESCRIPTION (provided by applicant): The proposed study responds to RFA-DA-08-007, which calls for research to "develop and test integrated drug use and HIV risk behavior prevention interventions in criminal justice settings". Despite the large and growing number of drug-involved female offenders under community supervision and accumulating evidence of their elevated risk for HIV/STIs, there remains a critical gap in evidence-based HIV prevention interventions for this population. The proposed study is designed to address this critical gap by conducting a randomized controlled trial (RCT) that will rigorously test the efficacy of a multimedia version of 4-session, gender-specific, integrated drug use and HIV/STI prevention intervention (Multimedia WORTH) in increasing condom use and decreasing the incidence of sexually transmitted infections (STIs) among 420 drug-involved female offenders in a large Alternative-to-Incarceration(ATI) Probation Program in New York City, compared to a non-media version of the same intervention (Traditional WORTH) and to a 4-session NIDA standard HIV prevention control condition, which is not gender-specific (NIDA Control). Participants will be assessed with repeated measures at baseline, immediate post test (IPT), 6-month, and at 12-month post-intervention follow-ups. Multimedia interventions have been found to be efficacious in promoting HIV risk reduction and reducing substance use compared to non-multimedia interventions. Furthermore, multimedia interventions hold promise for increasing the fidelity of implementation and the speed, scale and quality of dissemination. The Traditional WORTH intervention was developed by this study's investigative team as a group-based, integrated drug use and HIV prevention intervention for low income, urban female offenders which addresses intimate partner violence (IPV) and other gender specific risk factors for HIV. WORTH has been tested in two different RCTs and found to be efficacious in increasing condom use among drug-involved female inmates and among women in drug treatment. Multimedia WORTH contains the same content as Traditional WORTH, but employs multimedia interactive tools and culturally tailored animation and video enhancements that are designed to enhance the delivery of the intervention by maximizing individual learning opportunities and feedback, while at the same time optimizing the group format to build positive peer norms and social support for HIV risk reduction. This rigorous RCT will advance the science and extend the boundaries of multimedia HIV prevention research while aiming to close a critical gap in HIV prevention efforts in the criminal justice system. PUBLIC HEALTH RELEVANCE: The proposed study addresses a significant public health threat of HIV and other STIs among drug-involved female offenders under community supervision The proposed randomized controlled trial will rigorously test the efficacy of a gender specific multimedia HIV prevention intervention on increasing condom use and reducing incidence of STIs. This innovative multimedia approach may enhance the impact and delivery of standardized group-based HIV prevention interventions and holds promise for increasing capacity, quality, and speed in disseminating evidenced-based HIV prevention interventions in overburdened criminal justice settings.