Posts classified under: Youth and Adolescents

Engaging Seronegative Youth to Optimize HIV Prevention Continuum

Abstract: Young people at highest risk for HIV in the U.S. will be gay, bisexual transgender youth (GBTY) and homeless youth (HY) in communities with high HIV incidence and overwhelmingly Black and Latino. Focusing on Los Angeles and New Orleans, seronegative youth at highest risk for HIV will be screened in homeless shelters and gay-identified community-based organizations (CBO). A cohort of 1500 seronegative youth will be recruited that is 82% male (79% GBTY), 66% Black, 16% Latino, and 18% white, non-Hispanic. About 27% will be 12-17 and 73% between 18-24 years old. All youth will be followed longitudinally over 24 months at four month intervals and tested for HIV, STI, serious substance abuse, health care utilization, and comorbid conditions – a Prototypical Retention/Prevention (R/P) Strategy. Over 24 months, acutely HIV infected youth will be triaged to Study 1. This Prototypical R/P Strategy operationalizes the CDC’s recommendations for the engagement of GBTY in repeat HIV testing, linkage to care, and options for combination prevention (PrEP, PEP – with behavioral interventions). Building on this team’s extensive experience with behavioral and mobile/social media interventions, a randomized controlled trial (RCT) will be conducted with four intervention conditions: 1) an Automated Messaging and Monitoring Intervention (AMMI), which will use texts to diffuse prevention messages daily and to monitor risk behaviors weekly (n=900); 2) a Peer Support intervention on a social media platform (i.e., Facebook) in which young people will post messages and stories about their experiences preventing HIV, plus the AMMI (n=200); 3) an eNavigator intervention in which a B.A.-level staff supports youth, primarily through texting and social media, but also in-person meetings, to provide support in crisis situations, refer to treatment, and assist in gaining access to health care and other services, plus Peer Support and AMMI (n=200); and, 4) a combined intervention of eNavigator, Peer Support, and AMMI (n=200). A single outcome will be composed of six key behaviors (access to medical care, accessing and adherence to PrEP or PEP, treatment of all STI, and 100% condom use). In addition to evaluating the added benefit of increasing levels of intervention, the brief 7- item weekly text-messaging monitoring surveys will provide approximately 100,000 weekly reports of indicators of primary and secondary outcomes that can inform our understandings about the relationships between risk and comorbid states. This study will have policy implications for the allocation of resources to HIV testing resources in local communities, the uptake and scalability of text and social media interventions, and the models for diffusing evidence-based interventions (EBI) globally (without requiring replication with fidelity to a manual).

Project Number: 5U19HD089886-02

SMS as an Incentive to Adhere (SITA)

Abstract: HIV care requires high medication adherence to achieve optimal clinical outcomes such as slowing the progression to AIDS. Youths face special and unique challenges to adherence. Despite a wealth of interventions designed to increase adherence outcomes, few have focused on interventions that are sustainable in resource-limited settings, or for the period of adolescence. Developing ways to increase adherence rates among adolescents is particularly important as this groups experiences the fastest growth in new HIV/AIDS cases. Existing interventions often require scarce human resources, limiting their practical use. Novel ways of adapting traditional interventions in a sustainable manner are important in resource-limited settings, where second-line therapy is often too expensive or altogether unavailable. The recent rapid rise in mobile phone coverage and ownership among developing country populations has spawned the advent of mobile-phone based interventions to improve health service delivery; short message service (SMS)-based interventions have been found to increase adherence rates to ART among adult patients. However, more knowledge about this promising technology is needed as currently no clear-cut evidence exists about the pathways through which they work. The proposed study ‘SMS as an Incentive To Adhere’ (SITA) proposes novel ways of using SMS messages that are explicitly grounded in the theoretical framework of Social Cognitive Theory (SCT). The first intervention is that of self-monitoring, i.e. providing participants with feedback about their adherence performance. Traditionally this involves clinic visits that take up provider and patient time and resources; SIT instead suggests providing objective, real-time information measured by electronic monitoring (Wisepill) devices sent to patients by weekly SMS. Such feedback builds self-efficacy, a key SCT concept and so may contribute to improved adherence. The second intervention is based on the SCT concept of social learning. Perceived group norms, and interventions that affect those perceptions, are a key influence on health behavior among youths, providing a substitute for direct learning. This approach is adapted to a mHealth environment by providing patients not only with their own adherence information but also that of a reference (peer) group. The first aim of the study is to hold focus groups with key stakeholders to tailor the SMS-intervention to the local needs of youths. The second aim planned is a small, six-month randomized controlled trial testing the two SITA intervention groups against a control condition of usual care to determine which method of informing and motivating drug adherence can best achieve its goals. The third aim is to synthesize lessons learned and discuss them with the clinics and other key stakeholders. The purpose of such capacity building and knowledge transfer activities part of this study is to build up mHealth knowledge at Mildmay and Uganda more generally to a point where ideas can be generated and implemented locally.

Project Number: 5RMH107218-02

Use of Social Media to Improve Engagement, Retention, and Health Outcomes along the HIV Care Continuum – Evaluation and Technical Assistance Center

Abstract: The Evaluation and Technical Assistance Center (ETAC) will be comprised of a collaborative team of experts from the Department of Family Medicine and the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) at the University of California, Los Angeles (UCLA), and an expert from the University of California, San Francisco (UCSF). The ETAC is guided by three goals:

  1. To provide technical assistance to equip demonstration sites with the skills and capacity to design, implement, evaluate and sustain social media-based interventions to improve engagement and retention of HIV-positive youth and young adults in HIV medical care.
  2. To conduct a national, multi-site evaluation of social media-based interventions for HIV positive youth and young adults across demonstration sites. We will employ mixed methods to understand intervention effectiveness. Overall potential evaluation questions include:
    • To what extent is implementation of each demonstration project’s social media-based intervention associated with improvements in identification, engagement, treatment, adherence and retention in HIV care among youth and young adults living with HIV?
    • To what extent is implementation of each demonstration project’s social media intervention associated with improved utilization and adherence to appropriate HIV care and services?
    • To what extent does each demonstration project’s social media intervention improve behavioral and biomedical health outcomes among youth and young adults living with HIV?
    • To what extent is each demonstration project able to engage and retain HIV-positive youth and young adults in the use of their social media-based intervention?
    • What is the acceptability and usability of each demonstration project’s social media delivered interventions among HIV-positive youth and young adults?
    • What site, provider, and client characteristics are associated with engagement in HIV care, utilization of HIV clinical and support services, and/or behavioral and biomedical health outcomes?
    • What individual, interpersonal, cost, and community/societal factors are associated with engagement in HIV care, utilization of HIV clinical and social support services, and/or behavioral and biomedical health outcomes?
  3. To coordinate dissemination of findings. The ETAC will support demonstration sites in
    disseminating results to ensure that findings are widely distributed to diverse audiences. Based on the collaborative team’s research experience in using social media technologies, extensive experience providing technical assistance and training, and our ongoing experience implementing existing ETACs for other HRSA Special Projects of National Significance (SPNS), we are uniquely qualified to serve as the ETAC for this initiative

Structural Pathways for South African Men to Reduce Substance Abuse and HIV

Young men aged 18-25 years in South Africa face the intersecting epidemics of HIV, alcohol and drug abuse, and unemployment. This R34 is designed to reduce young men’s risk by addressing three problems with existing evidence-based programs (EBP): interventions are not designed considering men’s fight-flight coping strategy; donors are unwilling to invest in substance abusing men; and existing job training does not consider young men’s poor habits. Our goal is to apply behavioral economists’ strategies to new delivery formats that are highly attractive to young men: soccer and job training. A neighborhood-level HIV prevention strategy will shape men’s positive daily routines at an organized soccer league: being on time, completing practice, arriving sober & drug free, showing sportsmanship, and being nonviolent. Employment training by artisan trainers/mentors will be contingently offered to young men who demonstrate positive habits-of-daily-living on 80% of days over two months. Young township men in two neighborhoods will be randomized to receive the intervention that includes soccer, job training, and contingency management to shape behaviors (N=1 neighborhood; n=60 males) or to receive the control condition of soccer and job training without contingency management (n=1 neighborhood; 60 males).

Assessments will be at baseline and 6 months follow-up. We hypothesize the program will significantly reduce HIV-related sexual risk acts and substance abuse, and sustain more employment. We will evaluate life goals, consistency of daily routines pro-social acts, & family relationships. We will primarily evaluate intervention feasibility and uptake, and preliminarily evaluate intervention impacts and mediating factors for reducing HIV risk acts & substance use. We will also document stakeholders’ perceptions of the program’s challenges and successes via Key informant interviews, the number of young men in shebeens over time via observations, and the key features of the social movement strategies of the Sonke Gender Justice, a men’s advocacy movement.

HIV prevention efforts for young people in Sub-Saharan Africa have largely been unsuccessful: novel, structural, community level programs that address the social determinants of HIV are needed (Fenton, 2010; NIAID, 2010; Gupta et al., 2008). In particular, young South African men face many barriers, relative to women, to access and utilize HIV prevention programs, including that:

  • Young men are more likely to have concurrent sexual partners, abuse multiple substances, drop-outof school, and be unemployed, compared to women, creating greater challenges for behavior change(Kalichman et al., 2009; Wechsberg et al., 2008).
  • Many donor agencies are only willing to invest in women (Pronyk et al., 2007; Yunus, 2003). Men havegreater interpersonal power, are considered to be substance abusers who squander money and unreliable employees, making interventions difficult (Khandker, 2005; Wong et al., 2008).
  •  Existing prevention programs are more consistent with women’s coping styles “to tend and befriend” (Taylor, 2002). Men’s coping style of fight-flight (Tyrell, 2002) is less compatible with HIV’s current arsenal of evidence-based interventions (EBI) and microfinance program support groups (Kuhanen, 2009). Men are unlikely to attend stigmatized counseling sessions, typical of EBI (Peterson, 2007).
  • The existing R3 billion spent on government job training programs in South Africa (i.e., SETA) deliver didactic lessons. Fewer than 0.9% get on-the-job training or graduate (Bennel & Segrestom, 1998; Akojee & McGrath, 2007; Ziderman, 2003). High demand for relatively low skilled labor is filled by immigrants from neighboring African countries, rather than South Africans, leading to high unemployment and civil unrest.

This R34 aims to design a structural, community-level intervention to sustain self-protective acts among young, South African men aged 18-25 years. A two-pronged intervention is planned to acquire skills-of-daily- living (through soccer) and job skills (through artisan apprenticeships). Over two years, we will demonstrate the feasibility, acceptability, and uptake of the intervention components and outcome measures. We aim to shift four behaviors of young men: to increase consistent habits-of-daily-living, provide job skills and to decrease substance use and HIV-related sexual risk. Young men will be invited to play soccer daily, with contingency management in one neighborhood and not in another neighborhood.  If youth are adherent to the program, they will be offered on-the-job-training and receive artisan tools at graduation.

We will proceed in two phases:

In Phase 1, qualitative interviews will elicit information on men’s developmental pathways. Sonke Gender Justice, a South African NGO advocating for men’s mobilization for gender equity and respect for women, will recruit and train coaches for a daily soccer program and Artisans to deliver a job training program. While soccer is intrinsically rewarding, this pilot will evaluate whether a strategy of behavioral economists (i.e., contingency management) is needed to ensure high program uptake to shape four daily routines: showing up on time, sober & drug free, completing practice, and showing sportsmanship. Coaches will not be counselors or provided with specific scripts, but will be trained in the Street Smart EBI to learn the core intervention tools to problem solve challenges of daily living; create opportunities to dramatically demonstrate key health principles; to form solid bonds with young men; and to be knowledgeable about health risks and community resources. The artisan trainers will be local entrepreneurs making an income, who will receive training and support on how to mentor youth. Artisans will be supported to shape youth’s job behaviors, similar to our successful Uganda program (Rotheram-Borus et al., 2010; Lightfoot et al., 2009).

In Phase 2, a quasi-experimental design with two neighborhoods will be implemented. Neighborhoods have been matched on size, type and quality of housing, number of shebeens (bars), and length of residence. All young men aged 18-25 years in each neighborhood will be recruited to participate in a baseline interview (n=60/neighborhood). One neighborhood will be randomized to the Contingency Management Condition (CMC; n=60 youth) and one to the Control Condition (CC; N=60 youth) and reassessed at 6 months. Coaches will implement the soccer program in both neighborhoods; youth demonstrating consistent habits at soccer for at least two months will be offered access to four months of artisan training. Stakeholder interviews (n=10 at baseline and end of program in each neighborhood) and observations at local shebeens (n= 2/month @ 5 shebeens per neighborhood) will also be conducted to monitor community-level changes over time.

The specific aims of this project are:

  1. To describe perceived challenges of emerging adulthood among young men; and to document perceptions of the program’s challenges and successes, and the key features of the social movement strategies of the Sonke Gender Justice NGO partner that are associated with men’s successes.
  2. To document the program uptake, adherence, prosocial acts, and substance free days in CM vs no-CM.
  3. To examine if young men in the CM vs. no-CM control condition demonstrate significantly:

a. Fewer HIV-related sexual risk acts, less substance use, and more employment;
b. More positive life goals; consistent, healthy daily routines; & greater social support & prosocial acts.
c. To contrast the number of men in shebeens and clean substance use screens across conditions.

Story of Champions League Player Yolani Benge - Report

Teens and Adults Learning to Communicate (TALC: LA)

Project TALC was funded by the National Institute of Mental Health (NIMH) to evaluate the efficacy of a family-based intervention over time and to contrast the life adjustments of HIV-affected families and their non-HIV-affected neighbors in the current treatment era. Mothers living with HIV (MLH; n = 339) and their school-age children (n = 259) were randomly assigned to receive a behavioral intervention or standard care as the control condition. MLH and their children were compared to non-HIV-affected families recruited at neighborhood shopping markets.

Targeted Risk Group: 

HIV-positive mothers and their adolescent children

Published Journal Articles:

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Links to Interventions, Training Manuals, etc. : 

 Phase 1 – Taking Care Of Myself

Parents’ Curriculum

Phase 2 – Illness

Parents’ Curriculum

  1. TALC LA- Parents Phase 2, Sess 1: What Are My Children's Needs?
  2. TALC LA- Parents Phase 2, Sess 2: Who Will Take Care of My Children?
  3. TALC LA- Parents Phase 2, Sess 3: What Kind of Arrangements Can I Make?
  4. TALC LA- Parents Phase 2, Sess 4: How Do I Start My Plan?
  5. TALC LA- Parents Phase 2, Sess 5: How Can I Really Listen To My Children?
  6. TALC LA- Parents Phase 2, Sess 6: How Can I Tell My Children What I Feel?
  7. TALC LA- Parents Phase 2, Sess 7: How Should I Deal with Problem Behavior?
  8. TALC LA- Parents Phase 2, Sess 8: How Can We Create a Positive Atmosphere at Home?
  9. TALC LA- Parents Phase 2, Sess 9: How Can We Resolve Conflicts at Home? (Part 1)
  10. TALC LA- Parents Phase 2, Sess 10: How Can We Resolve Conflicts at Home? (Part 2)
  11. TALC LA- Parents Phase 2, Sess 11: How Can We Work Together on Selecting a Custodian?
  12. TALC LA- Parents Phase 2, Sess 12: How Can We Deal with Drugs and Alcohol?
  13. TALC LA- Parents Phase 2, Sess 13: How Do I Prevent Pregnancy and Fatherhood?
  14. TALC LA- Parents Phase 2, Sess 14: Where Am I in Making a Custody Plan?
  15. TALC LA- Parents Phase 2, Sess 15: How Can Mothers Encourage Safer Sex?
  16. TALC LA- Parents Phase 2, Sess 16: What is the Mother's Legacy and the Youth's Goals?

 Adolescents’ Curriculum

Phase 3 – Adjustment

New Caregivers and Teens’ Curriculum

  1. TALC LA- New Caregivers and Teens Phase 3, Sess 1: What Do Adolescents and Caregivers/Parents Need from Each Other?
  2. TALC LA- New Caregivers and Teens Phase 3, Sess 3: Dealing with Loss and Grief - Part I
  3. TALC LA- New Caregivers and Teens Phase 3, Sess 4 (Caregivers): Raising an Adolescent
  4. TALC LA- New Caregivers and Teens Phase 3, Sess 4 (Youths): Planning for My Future - Part I
  5. TALC LA- New Caregivers and Teens Phase 3, Sess 5: Dealing with Loss and Grief - Part II
  6. TALC LA- New Caregivers and Teens Phase 3, Sess 6: How Can We Improve Communication - Part I (Effective Expressing)
  7. TALC LA- New Caregivers and Teens Phase 3, Sess 7: Ways of Helping Someone Cope with Loss and Grief
  8. TALC LA- New Caregivers and Teens Phase 3, Sess 8: How Can We Improve Communication - Part II (Active Listening and Responding)
  9. TALC LA- New Caregivers and Teens Phase 3, Sess 9 (Caregivers): Caregiver Support
  10. TALC LA- New Caregivers and Teens Phase 3, Sess 9 (Youths): How Do I Achieve My Goals?
  11. TALC LA- New Caregivers and Teens Phase 3, Sess 10: (Joint) How Can We Deal With Anger in the Relationship?
  12. TALC LA- New Caregivers and Teens Phase 3, Sess 11: How Can I Cope with Sadness?
  13. TALC LA- New Caregivers and Teens Phase 3, Sess 12 (Caregivers): How Should I Deal with Problem Behavior?
  14. TALC LA- New Caregivers and Teens Phase 3, Sess 12 (Youths): How Do I Deal with Fear?
  15. TALC LA- New Caregivers and Teens Phase 3, Sess 13: How Do We Practice Safer Sex, Prevent Pregnancy, and Reduce Alcohol and Drug Use?
  16. TALC LA- New Caregivers and Teens Phase 3, Sess 14: How Can We Resolve Conflicts at Home?
  17. TALC LA- New Caregivers and Teens Phase 3, Sess 15: How Can We Create a Positive Atmosphere at Home?
  18. TALC LA- New Caregivers and Teens Phase 3, Sess 16: Looking to the Future Together, What Can We Do?

Young Adults’ Curriculum

  1. TALC LA- Young Adults Phase 3, Sess 1: How Are Things Going?
  2. TALC LA- Young Adults Phase 3, Sess 2: Planning for My Future - Part I
  3. TALC LA- Young Adults Phase 3, Sess 3: Dealing with Loss and Grief - Part I
  4. TALC- Young Adults Phase 3, Sess 4: Where and How Can Young People Get Support?
  5. TALC LA- Young Adults Phase 3, Sess 5: Dealing with Loss and Grief - Part II
  6. TALC LA- Young Adults Phase 3, Sess 6: Ways of Coping with Loss and Grief
  7. TALC LA- Young Adults Phase 3, Sess 7: Planning for My Future (Part II) - How Do I Achieve My Goals?
  8. TALC LA- Young Adults Phase 3, Sess 8: Hearing and Getting Heard
  9. TALC LA- Young Adults Phase 3, Sess 9: How Can We Deal with Anger?
  10. TALC LA- Young Adults Phase 3, Sess 10: Relationships and Sex (Part 1)
  11. TALC LA- Young Adults Phase 3, Sess 11: Relationships and Sex (Part 2)
  12. TALC LA- Young Adults Phase 3, Sess 12: How Can I Cope with Sadness?
  13. TALC LA- Young Adults Phase 3, Sess 13: Pregnancy and Parenthood
  14. TALC LA- Young Adults Phase 3, Sess 14: How Do I Deal with Fear?
  15. TALC LA- Young Adults Phase 3, Sess 15: How Can I Reduce Substance Use?
  16. TALC LA- Young Adults Phase 3, Sess 16: Looking to the Future

Intervention Model: 

Mothers and their adolescents attended a 16-session cognitive behavioral intervention over eight weeks. For MLH, intervention goals aimed to: 1) improve parenting while ill (i.e., reduce family conflict, improve communication, clarify family roles); 2) reduce mental health symptoms; 3) reduce sexual and drug transmission acts; and 4) increase medical adherence and assertiveness with medical providers. For adolescents, the intervention goals were to: 1) improve family relationships; 2) reduce mental health symptoms; 3) reduce multiple problem behaviors (e.g., drug use, criminal justice acts, school problems, teenage pregnancy); and 4) school retention.

Research Methods:

In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a control group on mental health and health behaviors, including sexual behavior and substance use. Both intervention and control families were compared to a neighborhood cohort, matched on sociodemographics. Because study participants were followed over two years, longitudinal random effect regression models were used to test the efficacy of the intervention.

Surveys and Scales Used:

  1. Living Situation, Including Neighborhood Problems - Scale
  2. Religion: Attendance and Experience
  3. Financial, Labor, and Educational Experience - Scale
  4. Loss and Grief - Scale
  5. Treatment History - Survey
  6. Social Support - Survey
  7. Romantic Relationships - Survey
  8. Needle Use and Sharing - Survey
  9. Reproductive Health - Survey
  10. Parentification - Survey
  11. Goals Scale
  12. Natural Mentors
  13. Dealing with Mother's Illness - Survey
  14. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
  15. Sexually Transmitted Disease - Survey
  16. Medication Adherence - Survey
  17. Educational (Academic) Experience Assessment
  18. Family Functioning - Scale
  19. Family Composition - Scale
  20. Employment and Labor Experience Assessment - Survey
  21. World Health Organization Quality of Life (WHOQOL) - Survey
  22. Self Harm: Suicide History - Survey
  23. CDC Sexual Behavior Questions (CSBQ)
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  25. Detention and Jail History Assessment - Survey
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  27. Alcohol and Other Drug Abuse (AOD) - Scale
  28. Adolescent Substance Use - Survey
  29. PTSD Index for DSM IV (Adolescent version) - UCLA
  30. Parker Parental Bonding Instrument
  31. Positive and Negative Affect Scale (PANAS)
  32. Network Assessment
  33. Janis Self-Esteem - Scale
  34. Medical Outcomes Study (MOS) Social Support - Survey
  35. Living Situation for Adolescents - Survey
  36. Life Outcome Expectancies Assessment - Survey
  37. Life Goals Assessment - Survey
  38. Life Events Assessment - Survey
  39. House Rules - Scale
  40. HIV Related Incidents - Survey
  41. Healthcare Utilization, Providers, and General Health Assessment: Including STD and Pregnancy - Survey
  42. HIV Testing Assessment - Survey
  43. General Medical History Assessment
  44. Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder
  45. Conflict Resolution - Conflict Tactics Scale (CTS)
  46. Adult Adolescent Parenting Inventory (AAPI) - Survey
  47. Nutrition and Exercise - Survey
  48. Rosenberg Self-Esteem (RSE) - Scale
  49. Dealing with Illness - Scale

Local Significance: 

There was a lack of significant findings for an intervention effect on HIV-transmission behaviors and mental health. HIV-transmission behaviors were low to begin with and participants had little room for improvement. The populations affected by the HIV epidemic in the U.S. have shifted over the past number of years since a similarly mounted intervention in New York City led to improvements. HIV interventions in the U.S. need to shift their focus to persons living with HIV who are experiencing substantial problems.

International Significance:

While the focus of U.S.-based HIV interventions need to shift, interventions for the general HIV population may be effective outside the U.S.

Together Learning Choices (TLC)

TLC (Together Learning Choices) is an HIV prevention and health promotion intervention developed for HIV-positive teens and youth (ages 13 to 29). TLC is delivered in small groups using cognitive-behavioral strategies to change behavior. It provides young people living with HIV the tools and skills necessary to live their best lives and to be able to make healthy choices. The goal of the intervention is to help these young people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. TLC is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.

TLC consists of two sequential modules that totaled 16 sessions. Each module has eight sessions and is designed to be delivered by two Facilitators in a group setting.

  •  The Staying Healthy module encourages healthy living by focusing on health maintenance and forging effective partnerships with health care providers.
  • The Acting Safe module is dedicated to primary and secondary HIV prevention by addressing sex- and substance use-related risk behaviors and reducing new infections and reinfections.

– The goal of this study was to design, pilot test, and evaluate an intervention for service providers to address HIV-related stigma and its impact on health service delivery and adequate care.
TLC is a science-based behavioral intervention that has demonstrated evidence of effectiveness in reducing risky behaviors, such as unprotected sex, or in encouraging safer ones, such as using condoms and other methods of practicing safer sex. It is offered by the Centers for Disease Control and Prevention (CDC) through the Replicating Effective Programs (REP) and Dissemination of Effective Behavioral Interventions (DEBI) at www.effectiveinterventions.org.

Targeted Risk Group:
Young People Living with HIV (YPLH) aged 13 to 24 in original efficacy trial and aged 13-29 in . The majority of participants were African-American and Latino.

Intervention model:
Small group intervention.
Original intervention manuals available here:

Module 1 – Staying Healthy

CDC funded replication manual: TLC Implementation Manual
TLC Broadsheet

Research Methods:
Group randomized trial with immediate intervention and delayed (waitlisted) control conditions. Assessment interviews conducted every three months over 24 months.

Local Significance:
The intervention reduced sexual risk behaviors, substance use, and emotional distress, and increased social support and other positive coping styles.

Recruiting and Engaging Adolescents in Creating Hope (Project REACH)

Project REACH aims to create an effective recruitment and retention method for family interventions for substance abuse and adapt culturally-appropriate substance abuse programs targeting African American adolescents who are enrolled in Los Angeles County Office of Education (LACOE) schools and their parents (parents includes an adult guardian).
Targeted Risk Group: 
Probation youth and their families in Los Angeles
Research Methods: 
The project has two phases. The first phase is to develop an effective way to recruit families into a family intervention for substance abuse and determine how to make the intervention culturally appropriate. The family intervention that will be adapted for this project is Families that Care: Guiding Good Choices ((aka “Preparing for the Drug Free Years”) (GGC). GGC has been proven to reduce substance abuse, address family conflict through problem solving and communication techniques, and finally increase family connectedness. These activities will be done in collaboration with school administrators, probation officials, teachers, students and parents through key informant interviews and focus groups. The second phase will pilot test the adaptation of GGC in a sample of 60 African American from LACOE schools and their parents.
Local Significance: 
Expect to improve recruitment and retention in GGC, and GGC will improve family functioning and mental health, and decrease problem behaviors (HIV risk behaviors, school performance and recidivism).

Nsindikanjake Vocational Training Project

Socio-economic status plays an important role in HIV risk and prevention. Specifically, poverty can lead to survival sex and unprotected sex. The Nsindikanjake Vocational Training Project, a collaboration between UCLA and the Uganda Youth Development League (UYDEL), aims to reduce HIV risk among urban Ugandan youth through vocational education and training.

From February 2005 to January 2006, 100 13- to 23-year-old participants were recruited from two different youth centers in the slums of Kampala, Uganda. Youth were randomized by site to an immediate vocational training intervention (N=50 youth) or a 4-month delayed vocational training (N=50 youth). Participants were assessed at baseline, 4, and 24 months later. Youth were asked about employment, sexual risk behaviors, delinquent behavior, quality of life, mental health symptoms, and drug use.Vocational education consisted of apprenticeships with local artisans for 4 to 8 hours, 5 days a week. Artisans received training in having conversations with youth about HIV and how to cope with unprofessional behavior (e.g., tardiness, hygiene problems). Youth in the delayed training condition received vocational training after a 4-month follow-up assessment was completed. The final assessment was administered 24 months after enrollment, by which time all youth had received training.
Vocational training may be highly useful in supporting the impact of HIV prevention. The participants receiving vocational training showed reduced delinquent behaviors and greater improvements in employment, life satisfaction, and social support compared to control participants. Both conditions demonstrated such improvements at two years, especially ongoing employment which remained strong.

Project i (Prevention Among Homeless Youth)

A number of studies have informed us about the substantial risk for HIV associated with chronic homelessness among youth in both the U.S. and Australia, even though these studies have typically been cross-sectional or samples of convenience. To understand the high seroprevalence rates among older homeless youth, the developmental trajectories into and out of risk for HIV and homelessness can best be understood from longitudinal studies of first time runaways, in which contextual factors (the national, community supports, street experiences, peers, and family) that influence these trajectories can be identified and observed over time.

The National Institute of Mental Health (NIMH) funds this study of new homeless young people. The purpose of the study is to understand the life course of new homeless youth and runaways. The study focuses on the many sources that are influencing youths pathways into and out of homelessness and risk for HIV, such as a youth’s family background, individual characteristics, personal resources, street experiences, peer social networks, interactions with social service providers, and informal support systems.

PROJECT i is following new homeless youth over time to see if they become more similar or dissimilar to experienced homeless youth. We know that among homeless youth, remaining homeless may only serve to increase their risk for HIV. This suggests a critical need to find ways to divert new homeless youth from the path of chronic homelessness and greater risk for HIV infection. The results of the study will be used to design interventions for new homeless youth to reduce their risk for HIV and to help inform service providers who may influence the life course of runaways and homeless youth and as a result help decrease their risk for HIV and becoming chronically homeless.

Approximately 240 youth, ages 12 to 20 years, are being recruited throughout various parts of Los Angeles County. A similar sample is being recruited in Melbourne, Australia. Youth who report having left home no more 180 days are eligible to participate in the study. An additional 200 youth per year, ages 12 to 20 years, who report having left the home for more than 180 days and who do not meet the above criteria, are eligible to participate in a one-time interview as part of a comparison group.

Following a baseline interview, study participants are interviewed at three months and then every six months for a total of eight interviews over a three-year period. Interviews take approximately one hour to complete. The baseline interview is conducted at the shelter or center where the youth was recruited. Follow-up interviews are conducted at a place convenient for the youth.

Interventions for Substance-Using Youth Living with HIV

Project Name: 
Interventions for Substance Using Youth Living with HIV
Project Type: 
Living with HIV
Substance Abuse
Interventions for Substance Using Youth Living with HIV
Project Description:
Increasing numbers of youth are infected with HIV and are confronted with a series of challenges: stopping HIV transmission to others, maintaining health care regimens, improving their quality of life. Over the last 4 years, an intensive 31-session, 3-module intervention was designed, implemented, and evaluated to help youth living with HIV (YLH) meet these challenges. YLH significantly changed behaviors; however, a restructuring of the intervention is required based on new information from our previous study and new scientific breakthroughs: 1) only 30% of YLH continue their substance use and sex risk after learning they are seropositive 2) 30% of YLH never attended any group session, and 3) the recent scientific advances in HIV require addressing beliefs regarding post-exposure prophylaxis, life expectancies, undetectable viral loads, and the role of substance use in adhering to new medical regimens.Therefore, building on the positive results of the previous study, a secondary prevention program, CLEAR (Changing Lifestyles: Effort And Rewards) will be evaluated over 21 months for 200 substance-using YLH (aged 13-23) in Miami and LA. In addition, we will examine I) how YLH’s substance use influences seeking and adhering to combination antiretroviral therapies,and youth’s reinitiation of transmission acts based on their viral loads, beliefs regarding transmissivity of undetectableviral loads, as well as beliefs in post-exposureprophylaxis and life expectancies; 2) how well the components of the Social Action Model predict reductions insubstance use, sexual behaviors, relapse, improvements in health adherence,acquisition of knowledge of the program, and quality of life (3) the cost effectiveness of delivering the prevention program to YLH, as well as monitoring costs for health utilization for medical, nonmedical services, and differential benefits of telephone groups, individual sessions, and small groups (from previous study).
Scope:
The youth will be randomly assigned to a 3-module intervention (totaling 18 sessions)that is delivered in either a)anonymous telephone groups or b) individual sessions. Based on the Social Action Model, the intervention will 1) in Module 1, reduce substance use sexual behaviors that may transmit or enhance transmission of the HIV virus. 2) in Module 2, reduce the negative impacts of substance use on seeking and utilizing healthcare, and increase assertiveness and adherence to health regimens. 3) In Module 3, enhance quality of life and self-actualization in order to maintain behavior changes over time.

National Institute on Drug Abuse, Grant 5R01DA07903-08

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