Peer Versus Adult-Led HIV Prevention for Juvenile Offenders: Effectiveness and Costs

 说明(申请人提供)：少年犯是不成比例的少数民族，受艾滋病毒、性传播感染(STI)、精神疾病和药物滥用的影响。1-19在青少年司法环境中迫切需要循证方案(EBP)，但很少存在，对于那些确实需要循证方案的人来说，执行缓慢、具有挑战性，而且很难持续。然而，在没有干预的情况下，年轻罪犯在缓刑期间继续从事危险行为，放大了他们自己的行为，并加剧了本已严重的健康差距。改变这一轨迹是公共卫生的首要任务。这项研究建立在调查团队与库克县青少年缓刑和法院服务(美国第二大青少年缓刑系统)之间长达10年的合作基础上。开发和交付Phat Life，一款专为青少年罪犯量身定做的全面降低风险的EBP。Phat Life最近的疗效试验结果显示，在12个月的随访中，性行为风险和药物使用持续减少。下一步是确定在青少年缓刑范围内既可持续又具有成本效益的实施战略。此前很少有研究比较同伴主导和成人主导的行为改变计划，现有研究存在严重的方法缺陷。20本研究将比较青少年缓刑夜间报告中心中两种实施策略的有效性、成本效益和可持续性，即同伴领导和缓刑工作人员领导的Phat Life。同龄人将是以前参与少年司法的年轻人，他们在少年咨询委员会(青年代表)任职。青年代表和缓刑工作人员都将接受广泛的培训、监督和忠诚度监测。我们将比较Phat Life对300名13-17岁男女罪犯的风险性行为、性传播感染、药物使用和理论调解人的影响、成本和成本效益，当由青年代表和缓刑工作人员提供时。我们将使用定性的方法，征求青年代表、缓刑工作人员和缓刑管理人员对在少年司法中加强Phat Life可持续性的策略的意见，并探讨提供Phat Life对青少年代表性风险、药物使用和其他重要结果的影响。这项建议通过解决感化青年中艾滋病毒/性传播感染风险、药物使用和精神疾病等相互关联的问题及其负面的长期轨迹，满足了青少年司法环境中对EBP的迫切需求。比较两种实施策略--同伴与缓刑人员--以确定更有效和更具成本效益的方法，将加快艾滋病毒和其他性传播感染风险极高的青少年对急需的EBP的接受、交付和可持续性。

 DESCRIPTION (provided by applicant): Juvenile offenders are disproportionately minorities and affected by HIV, sexually transmitted infections (STI), mental illness, and substance use.1-19 Evidence-based programs (EBP) are sorely needed in juvenile justice settings, yet few exist, and for those that do, implementation has been slow, challenging, and rarely sustained. Yet without intervention, young offenders continue to engage in risk behaviors while on probation, amplifying their own and worsening already serious health disparities. Altering this trajectory is public health priority. This study builds on a 10-year collaboration between the investigative team and Cook County Juvenile Probation and Court Services (the second largest juvenile probation system in the U.S.) to develop and deliver PHAT Life, a uniquely-tailored comprehensive risk reduction EBP for young offenders. Findings from PHAT Life's recent efficacy trial reveal sustained reductions in sexual risk taking and substance use at 12-month follow up. The next step is to identify an implementation strategy that is both sustainable and cost-effective within juvenile probation. Few previous studies have compared peer- vs. adult- led behavior change programs and existing studies suffer from significant methodological deficiencies.20 This study will compare the effectiveness, cost-effectiveness, and sustainability of two implementation strategies, peer-led vs. probation staff-led PHAT Life, in juvenile probation's Evening Reporting Centers. Peers will be young adults formerly involved in juvenile justice who serve on the Juvenile Advisory Council (Youth Representatives). Both Youth Representatives and probation staff will receive extensive training, supervision, and fidelity monitoring. We will compare the impact, costs, and cost-effectiveness of PHAT Life on 300 13-17 year-old male and female offenders' risky sex, STI, substance use, and theoretical mediators when delivered by Youth Representatives vs. probation staff. Using qualitative methods, we will elicit the views of Youth Representatives, probation staff, and probation administrators regarding strategies to enhance PHAT Life's sustainability within juvenile justice, and we will explore the impact delivering PHAT Life on Youth Representatives' sexual risk, substance use, and other important outcomes. This proposal answers a compelling need for EBP in juvenile justice settings by addressing the interrelated issues of HIV/STI risk, substance use, and mental illness among probation youth, and their negative long-term trajectories. Comparing two implementation strategies--peers vs. probation staff--to determine the more effective and cost-effective approach will expedite uptake, delivery, and sustainability of much-needed EBP for teens who are at greatly elevated risk for HIV and other STIs.