Youth and Adolescents - CHIPTS - Center for HIV Identification, Prevention and Treatment Services

23Jan

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.

23Jan

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.

20Jan

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

20Jan

Grief Interventions for PLAs, Adolescents and Guardians

By the year two thousand, 80,000 children will be orphaned by AIDS in the U.S. and this number will continue to rise. Parental death during one’s childhood has been consistently associated with negative outcomes for children, however, there have been no prospective studies of adolescent bereavement from any type of parental death, including death from AIDS. This continuation study is aimed at delivering and evaluating an intervention to alleviate grief associated with the death of a parent. These results are likely to have implications for millions of AIDS orphans internationally and for the 550,000 US adolescents bereaved annually by parental death.

Scope:

Over the last two and a half years, 310 parents living with AIDS (PLAs) and their 498 adolescent children, age 12-18 were recruited. They were randomly assigned to receive: (1) a standard care condition in which extensive social welfare services are provided; or (2) an enhanced care condition in which three modules of coping skills intervention (Project TALC: Teens and Adults Learning to Communicate) plus social services are provided. Linked to the phases of parental illness, PLAs, their adolescents, and new custodial guardians are schedule to meet individually and jointly in over 32 sessions. Because the life span of women with AIDS extended from 14.3 months to 27 months over the last two years, about two thirds of the sample of PLAs continue to live longer than anticipated, delaying the delivery of the final intervention module. Over the next 18 months, the investigator anticipates that the PLAs will die, and the final, post-death module of the intervention will be delivered. The present continuation study will allow the investigator to complete the delivery and the evaluation of the intervention, and in addition, pursue the following activities: (1) follow youths of PLAs prospectively and longitudinally for four additional years to evaluate their mental health, behavioral, and social outcomes; (2) complete the delivery and evaluation of the enhanced coping skills intervention, particularly of Module 3 to new custodial guardians and youths; and (3) develop new measures of grief to describe the bereavement process over time.

Parents living with AIDS reported a mean of 3.3 (SD=1.3) areas of conflict with their adolescents and 1.5 (SD=1.7) stressful parenting events over the previous three months. The parents were very ill, with many physical symptoms and diseases. Simultaneously, substance use was common (17% used daily), but not injection drug use (3.3%). Half had a sexual partner (63% protected partners by using condoms consistently). Regression analysis revealed that parent-adolescent conflict was significantly associated with high parental drug use: stressful parent events were significantly related to the lifestyle (high drug use and frequent sex acts) of Latino and African-American parents, but not white parents. In contrast to parents with other illnesses, parent-adolescent conflict and stressful parenting events were not influenced by parents’ health status, but were significantly influenced by substance use and sexual lifestyles. Both mothers (87%) and fathers were significantly more likely to disclose their serostatus to adolescents (73%), compared to younger children (23%). Only 44% disclosed to all their children; 11% disclosed to none. Most PLAs (80%) discussed custody plans; however, only 30% initiated legal plans, typically for younger children. Adolescents informed of their PLA’s serostatus engaged in more sexual risk acts, smoked more cigarettes, reported more severe substance use, and greater emotional distress than did uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or followup.

National Institute of Mental Health, grant 2R01MH49958-06

20Jan

Adolescent Trajectories for Homelessness and Risk for HIV

Abstract: 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 (FTR). Among these youth contextual factors (the national, community supports, street experiences, peers, and family) that influence these trajectories can be identified and observed over time. To obtain a contrast for the policy and provider context, comparisons between FTR in Australia and the U.S. are proposed. Australia differs from the U.S. in policies of harm reduction, needle exchange, national programs for positive sexual health, and the organization and distribution of community resources for homeless youth. The results will be used to design interventions for FTR to reduce their risk for HIV and for providers who may influence their trajectories into increasing or decreasing risk for HIV and becoming chronically homeless.

Scope:
A representative sample of FTR will be recruited in LA, CA and Melbourne, Australia (n=480) stratified by gender (120 males & 120 females per city; aged 11-17 years). Across cities, information will be collected at recruitment, 3, 6, 12, 18, 24, 30, and 36 month intervals from youth regarding four domains:

1) the individual’s risk for HIV (substance use & sexual behaviors) and chronic homelessness;

2) street experiences (daily activities, survival strategies, violence, delinquent acts and school/employment patterns) and personal resources (social identifiers, goals, coping styles, psychiatric distress);

3) the contest of the peers’ risk acts and community factors (e.g. service provider, policy factors, and informal networks) that influence youth’s response to becoming homeless; and

4) background characteristics of the youth and their families.

To further understand the social and structural context of youth’s HIV-related developmental trajectories, the empirical assessments of the FTR will be complemented by qualitative case descriptions gathered from three additional sources:

1) annual empirical assessment of samples of Experienced Runaways (three cross-sectional samples gathered annually, n=200 per city), in order to describe differences in the culture of homelessness over time and the drift over time in the similarity/differences between Experienced Runaways and FTR;

2) case studies of HIV-related policies and service providers for runaways in each city (n=20); and 3) qualitative interviews of a subset of FTR regarding their social networks (n=25/city).

Project Number:5R01MH061185-05

https://reporter.nih.gov/search/-NHT0_9De0a4DziGNX5tYw/project-details/6613496

Contact PI/ Project Leader

MILBURN, NORWEETA GERMAINE, PROFESSOR-IN-RESIDENCE (NMilburn@mednet.ucla.edu)

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

FOA: Unavailable / Study Section: Special Emphasis Panel[ZRG1-AARR-7(03)S]

Project Start Date: 30-September-1999

Project End Date: 31-May-2005

Budget Start Date: 01-June-2003

Budget End Date: 31-May-2005

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH/ FY Total Cost by IC:$792,640

20Jan

IMAGE Program

The incidence of HIV is high among women of childbearing age in the U.S., and mothers living with HIV (MLH) report their greatest source of stress is combining the maternal role with the psychological and medical demands of coping with a chronic, life-threatening condition.

The purpose of this R01 pilot study is to develop and then test the feasibility of implementing a parenting intervention for HIV-infected mothers with well children age 6–14 years old. The intervention is designed to improve parenting skills and maternal self-care skills in order to improve child and maternal outcomes. The basis for development of this intervention is work from two previous R01s (MH # 5R01MH057207, currently Yr. 12) designed to longitudinally assess HIV-positive mothers and their children.

MLH (n = 60) and their children (total N = 120) will be recruited, randomized to a theory-based, skills training intervention or a control condition, and assessed at baseline and 3, 6, and 12-month follow-ups. The intervention (“Improving Mothers’ parenting Abilities, Growth, & Effectiveness”—the IMAGE program) will consist of 5 sessions, and will be based on the Information – Motivation – Behavioral Skills (IMB) model of health behavior change, with specific skills selected based on our 10-year observational study of MLH and their children, which is on-going at UCLA. A random subset of 40% of the intervention mothers (n = 12) will be asked to participate in an in-depth qualitative interview after their last follow-up, to obtain detailed process information on their experiences in the intervention.

The main aims of this randomized pilot trial are to:

Develop the intervention and then evaluate the feasibility and acceptability of implementing the 5-week, theory based, individual behavior intervention to enhance positive parenting skills of MLH; and
Conduct preliminary evaluation of the data for effect sizes and investigate trends in the data for
- - Parenting practices outcomes (utilizing the parent practices scale), and secondary outcomes of parenting efficacy
  - Parenting behaviors targeted (parent-child communication, parental monitoring, family routines, and appropriate parentification) and the self-care skills targeted (social support, disclosure, dealing with perceived stigma)
  - Maternal outcomes for mental health indicators and physical health indicators
  - Child outcomes of mental health indicators, behavioral problems, and self-concept and coping
  - Family outcomes (family functioning, parent-child relationship)

We are now in the third decade of the HIV epidemic, and few interventions, other than for prevention or medication adherence, are available for women living with HIV; this study will be the first step in the evaluation an intervention that will assist HIV-positive mothers in dealing with the stress of parenting while coping with HIV. The pilot data will lead to a future application for a full-scale trial of the intervention to test efficacy.

20Jan

Teens and Adults Learning to Communicate (TALC: NYC)

Teens and Adults Learning to Communicate

Project TALC was funded by the National Institute of Mental Health (NIMH) and is an intervention designed to improve behavior and mental health outcomes among parents with AIDS and their adolescent children. The study sample was comprised of 307 financially-needy, AIDS-infected parents in New York City and 412 adolescent children. The majority (80%) of the parents were mothers. Approximately one-half of the study participants were Latino and over one-third were African American.

Targeted Risk Group:

AIDS-infected parents and their children

Intervention model:

Cognitive behavioral intervention comprised of two modules. The first module was for parents only (8 sessions) and focused on coping with the HIV illness and disclosure. The second module was for parents and their adolescents (16 sessions) and focused on ways to plan a legacy, e.g. making custody arrangements.

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. Because participants were followed over time, longitudinal random effect regression models were used to test the efficacy of the intervention.

Local Significance:

Over the two-year follow-up period, adolescents assigned to take part in the intervention reported significantly and substantially lower levels of emotional distress, conduct problems, and family-related stressors and higher levels of self-esteem than did control group adolescents.

International Significance:

Project TALC provided a behavioral intervention that can be adapted for other countries and cultures to improve behavior and mental health outcomes among parents with AIDS and their adolescent children.

Published Journal Articles:

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Please see TALC LA for the up-to-date intervention manuals.

Surveys and Scales Used:

TALC NYC Broadsheet

20Jan

Street Smart Uganda; UYDEL

Targeted Risk Group:

Urban Ugandan youth (UYDEL)

Street Smart was an intensive HIV/AIDS program for slum youths whose behaviors place them at risk of becoming HIV infected. It was implemented in collaboration with Uganda Youth Development Link.

Based on the fact that adolescence is a time of experimentation and developmental change in behavior, thoughts and emotions, Street Smart linked feelings, thoughts, emotions and attitudes to behavior change.

In 2007, nearly 1 million young people became infected with HIV in sub-Saharan Africa. Existing prevention programs have not been effective, prompting more attention toward the social determinants of HIV, such as unemployment. Without hope for the future, it is unlikely that young people will be motivated to remain free of HIV, as poverty creates vulnerability to survival sex or sex without condoms. The Street Smart intervention was developed in the United States to eliminate or reduce HIV risk behaviors among young people. Despite its success, it does not address the problems of economic vulnerability and investment in the future. The aim of this study was to test the added value of vocational training provided to urban Ugandan youth, in addition to the Street Smart HIV prevention program.

Download the UYDEL 2010 brochure here: Uganda Youth Development Link (UYDEL) (2010) - Brochure

Interventions, Training Manuals, etc. :

Intervention model:

Street Smart consists of a total of 10 sessions (eight two- hour group sessions, one individual session and a group visits to a community health resource), exposes youth to information regarding HIV/AIDS, drug abuse, condom use, personalized risks, negotiating safer sex, recognizing and coping with feelings and self talk. Intervention sessions included participatory discussions, role-plays & use of tokens. Participants were divided into groups consisting of 8 to 9 members per group. Each group attended 3 sessions a week, each session lasting an average of 2hrs and 30 minutes.

Research Methods:

The project included a total of 50 street and slum youth from two slum centers in Kampala. Participants completed a behavioral assessment at baseline and at 4-months. Twenty-five participants from one slum center initially served as the control group and received the intervention after their 4-month follow-up assessment. Twenty-five participants from the second slum center received the 10-session HIV prevention intervention immediately following their Baseline assessment.

Local Significance:

A total of 24 participants (96%) completed the entire 10 session intervention. The youth were also linked to important support services available to them. Given the small sample size and limited statistical power, longitudinal hierarchical linear models to examine the efficacy of the intervention were not appropriate. However, feedback gathered from both the youth participants and research staff, the intervention was very well-received. The youth’s engagement in the intervention is also apparent in the extremely high completion rate of the intervention.

International Significance:

There were two primary objectives to the collaboration with Uganda Youth Development. The first objective was to build the research capacity and skills among the team of Uganda collaborators. During the course of the project, the UCLA team conducted non-formal and formal training activities in Uganda. The second objective was to adapt, implement, and evaluate the efficacy of the adapted HIV prevention intervention with street and slum urban youth in Kampala, Uganda. This was accomplished through the collaborative effort of the UCLA researchers and the Uganda research team.

The Street Smart intervention continues to be implemented by the staff at UYDEL, demonstrating the staff support and commitment to the intervention and the work completed through the research. Mr. Rogers Kasirye has consulted with other Ugandan agencies regarding the development of interventions and research with street and slum youth in Uganda.

Despite some study limitations, the results suggest that at 4 months the vocational training program improved employment, satisfaction with life, and social support; and reduced delinquent behaviors. Vocational training plus Street Smart improved social support and reduced sexual risk-taking, delinquent behavior, and substance use at 2 years. Fewer than half had ever worked prior to the program, but over 80% were employed at 2 years. Larger trials of HIV interventions addressing social determinants are warranted.

20Jan

Support To Reunite, Involve and Value Each Other (STRIVE)

The STRIVE program aimed to improve residential stability and the quality of residential life, reduce the number of runaway episodes, as well as reduce HIV-related sexual and substance use risk acts. Family conflict is found to cause runaway episodes for youth. Targeting newly homeless youth, this study developed and implemented a 5-session family-based intervention. STRIVE sessions take place with families while youth are still in shelters and/or being served by community agencies, and as they transition back to the home.

Surveys and Scales Used:

Targeted Risk Group:

Newly homeless youth in Los Angeles

Intervention model:

A behavioral family-based intervention model was used to address family conflict and promote positive family-child interactions.

Research Methods:

This study consisted of two phases Phase 1 was focus groups and key informant interviews to develop research design, measures, an intervention activities. Phase 2 implemented family intervention sessions with baseline and 3, 6, 12, 18, 24 month follow ups.

Local Significance:

Positive outcomes for reducing HIV risk behaviors and improving mental health.

International Significance:

N/A

20Jan

Street Smart (US)

Runaway and homeless youth have a national seroprevalence rate of 2.3%, a rate about six times higher than adolescents in the major AIDS epicenters.

Links to Interventions, Training Manuals, etc. :

Targeted at homeless and runaway youth, the Street Smart intervention was designed to reduce high-risk sex and drug using behaviors that can lead to HIV infection. However, 12 months after the original intervention, relapse occurred in approximately 15% of those who had previously changed their behavior, and long-term effects were only found in girls. Street Smart: Skills Maintenance addressed the problem of relapse by delivering an additional intervention post-Street Smart, Stayin’ Street Smart. Stayin’ Street Smart was a website that provided skill training, social support, informational updates, and access to an expert for consultation, including problem solving for emerging crises.

In addition to measuring the effectiveness of the maintenance intervention, Street Smart: Skills Maintenance examined the program’s effect over time on multiple problem behaviors (sex work, conduct problems, delinquency, school/employment, violence, chronic homelessness), examined the acceptability of the strategies by youth, and documented patterns of maintenance over time.

Participants:

Approximately 474 homeless and runaway youth between the ages of 12-24 were recruited through community-based agencies and homeless shelters in Los Angeles, CA.

Targeted Risk Group:

Homeless and runaway youth between the ages of 12-24

Local Significance:

Research on the use of Street Smart documented positive outcomes in reducing sexual risk behaviors among females and substance use among both male and female runaways over 2 years (Rotheram-Borus et al. 2003). Outcomes from Street Smart: Maintenance have not been published.

International Significance:

Globally, there are approximately 100 million homeless youth (UNICEF 1989). Strategies to maintain reductions in sexual risk behaviors and substance use found to be effective in homeless and runaway youth in the United Stated could be adapted to help homeless and runaway youth in other countries

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Posts classified under: Youth and Adolescents

Download the UYDEL 2010 brochure here: Uganda Youth Development Link (UYDEL) (2010) - Brochure