HIV/STI Prevention for Adolescents With Substance Use Disorders in Treatment
| Status: | Completed |
|---|---|
| Conditions: | Infectious Disease, HIV / AIDS, Psychiatric |
| Therapuetic Areas: | Immunology / Infectious Diseases, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 13 - 24 |
| Updated: | 4/21/2016 |
| Start Date: | August 2010 |
| End Date: | August 2015 |
Adolescents with substance use disorders (SUD) are at substantial risk for contracting
HIV/STIs compared to their counterparts without SUD, yet few HIV/STI sexual risk reduction
interventions have been developed to meet their unique needs, and none use a family-based
intervention approach, which the literature recommends as the focus for intervention for
youth. Current state policies neither require providers in clinics delivering substance use
treatment to offer HIV/STI sexual risk reduction nor offer providers tools or training for
HIV/STI prevention. There is clear public health need to develop innovative methods of
service delivery and effective strategies of HIV/STI sexual risk reduction that address
multiple contexts of risk (i.e. family) for this high risk population. The current proposal
addresses this need by developing a provider-delivered HIV sexual risk reduction
intervention to be implemented in outpatient SUD treatment that: 1) builds the clinics'
capacity to help families under their care to more comfortably address the adolescent's
sexuality; 2) promotes youth's safer sex practices; and 3) reduces HIV/STI sexual risk
behaviors among adolescents with SUD in care.
HIV/STIs compared to their counterparts without SUD, yet few HIV/STI sexual risk reduction
interventions have been developed to meet their unique needs, and none use a family-based
intervention approach, which the literature recommends as the focus for intervention for
youth. Current state policies neither require providers in clinics delivering substance use
treatment to offer HIV/STI sexual risk reduction nor offer providers tools or training for
HIV/STI prevention. There is clear public health need to develop innovative methods of
service delivery and effective strategies of HIV/STI sexual risk reduction that address
multiple contexts of risk (i.e. family) for this high risk population. The current proposal
addresses this need by developing a provider-delivered HIV sexual risk reduction
intervention to be implemented in outpatient SUD treatment that: 1) builds the clinics'
capacity to help families under their care to more comfortably address the adolescent's
sexuality; 2) promotes youth's safer sex practices; and 3) reduces HIV/STI sexual risk
behaviors among adolescents with SUD in care.
The incidence of HIV and (sexually transmitted infections) STI continues to rise in the US
among youth, and rates of HIV/STI sexual risk behaviors among adolescents with substance use
disorders (SUD) are significantly higher compared with their counterparts without SUD. Yet
HIV/STI sexual risk reduction is not regularly implemented within adolescent SUD treatment
programs. To address this urgent public health priority, the investigators propose first to
develop a manualized sexual risk reduction intervention that 1) builds community clinics'
capacity to help families in their care to address systematically adolescents' sexuality; 2)
promotes the youths' safer sex practices; and 3) reduces HIV/STI sexual risk behaviors among
adolescents with SUD in treatment. Second, the investigators propose to pilot test the
manualized intervention to examine feasibility and acceptability of implementation in
real-world settings and determine optimal research parameters for such settings in
preparation for a randomized clinical trial (RCT). The intervention development process will
use a Community Based Participatory Research model of adaptation and development that has
been successfully implemented by the PI in other settings. The investigators will conduct
formative work to guide adaptation of a multi-family group HIV/STI sexual risk reduction
intervention that has demonstrated efficacy with youth, ages 13-18, who have non-SUD
psychiatric disorders (Project STYLE: Strengthening Today's Youth Life Experience; R01
MH63008; PI: Brown). This formative work (Phase 1 - protocol 6183) will leverage the
research sample of CASALEAP, an ongoing NIDA-funded, large-scale naturalistic study of the
effectiveness of outpatient SUD treatment for adolescent (R01 DA019607; PI: Hogue). The
resulting new manualized intervention (STYLEnS: STYLE and Substance) then will be
pilot-tested (Phase 2 - protocol 6622) with a sample of male and female adolescents with SUD
(n=60) in treatment in three well-established New York City mental health outpatient
treatment programs which are typical of those for adolescents with SUD and in which the
investigators have active partnerships. Pilot participants will be randomly assigned to
either STYLEnS or an attention control intervention (Health Promotion). Participants will
receive a full-day group intervention on the day of randomization (multi-family, caregivers
alone and adolescents alone), return in two weeks for an individual adolescent/caregiver
dyad session, and participate in a half-day booster group session three months later. The
pilot test will evaluate the feasibility and acceptability of conducting an intervention in
outpatient clinics treating adolescents with SUD, examine optimal factors influencing
research methods, and estimate intervention parameters for a RCT. Acceptability and
feasibility will be assessed using process measures following each session as well as after
the intervention is completed. The investigators will assess change in sexual risk behavior
outcomes from baseline to 3 months post-intervention. This study will lay the groundwork for
refining the design of a RCT of the new intervention. Implementing a HIV/STI sexual risk
reduction intervention in clinics providing SUD treatment represents an innovative and
potentially cost-effective approach to enable typically overburdened SUD treatment providers
to address the heightened HIV/STI risk in SUD youth. This proposal responds to the need to
develop HIV/STI sexual risk reduction intervention services for adolescents with SUD that
can be applied in and easily disseminated to clinical settings.
among youth, and rates of HIV/STI sexual risk behaviors among adolescents with substance use
disorders (SUD) are significantly higher compared with their counterparts without SUD. Yet
HIV/STI sexual risk reduction is not regularly implemented within adolescent SUD treatment
programs. To address this urgent public health priority, the investigators propose first to
develop a manualized sexual risk reduction intervention that 1) builds community clinics'
capacity to help families in their care to address systematically adolescents' sexuality; 2)
promotes the youths' safer sex practices; and 3) reduces HIV/STI sexual risk behaviors among
adolescents with SUD in treatment. Second, the investigators propose to pilot test the
manualized intervention to examine feasibility and acceptability of implementation in
real-world settings and determine optimal research parameters for such settings in
preparation for a randomized clinical trial (RCT). The intervention development process will
use a Community Based Participatory Research model of adaptation and development that has
been successfully implemented by the PI in other settings. The investigators will conduct
formative work to guide adaptation of a multi-family group HIV/STI sexual risk reduction
intervention that has demonstrated efficacy with youth, ages 13-18, who have non-SUD
psychiatric disorders (Project STYLE: Strengthening Today's Youth Life Experience; R01
MH63008; PI: Brown). This formative work (Phase 1 - protocol 6183) will leverage the
research sample of CASALEAP, an ongoing NIDA-funded, large-scale naturalistic study of the
effectiveness of outpatient SUD treatment for adolescent (R01 DA019607; PI: Hogue). The
resulting new manualized intervention (STYLEnS: STYLE and Substance) then will be
pilot-tested (Phase 2 - protocol 6622) with a sample of male and female adolescents with SUD
(n=60) in treatment in three well-established New York City mental health outpatient
treatment programs which are typical of those for adolescents with SUD and in which the
investigators have active partnerships. Pilot participants will be randomly assigned to
either STYLEnS or an attention control intervention (Health Promotion). Participants will
receive a full-day group intervention on the day of randomization (multi-family, caregivers
alone and adolescents alone), return in two weeks for an individual adolescent/caregiver
dyad session, and participate in a half-day booster group session three months later. The
pilot test will evaluate the feasibility and acceptability of conducting an intervention in
outpatient clinics treating adolescents with SUD, examine optimal factors influencing
research methods, and estimate intervention parameters for a RCT. Acceptability and
feasibility will be assessed using process measures following each session as well as after
the intervention is completed. The investigators will assess change in sexual risk behavior
outcomes from baseline to 3 months post-intervention. This study will lay the groundwork for
refining the design of a RCT of the new intervention. Implementing a HIV/STI sexual risk
reduction intervention in clinics providing SUD treatment represents an innovative and
potentially cost-effective approach to enable typically overburdened SUD treatment providers
to address the heightened HIV/STI risk in SUD youth. This proposal responds to the need to
develop HIV/STI sexual risk reduction intervention services for adolescents with SUD that
can be applied in and easily disseminated to clinical settings.
Inclusion Criteria:
1. are in care at the pilot sites;
2. are ages 13-24 years;
3. meet criteria for (Diagnostic Statistical Manual) DSM-IV substance abuse diagnosis
(patient record);
4. have a caregiver who will consent to their study participation,
5. have a parent/family member willing to enter treatment and participate in study
Exclusion Criteria:
1. have mental retardation or pervasive developmental disorder as primary diagnosis;
2. have a medical or psychiatric illness requiring hospitalization;
3. have current psychotic features, or current suicidality;
4. are not English- or Spanish-speaking
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