The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
J Adolesc Health. 2010 Jan;46(1):11-6. doi: 10.1016/j.jadohealth.2009.05.017. Epub 2009 Aug 18.
To describe multiple risk behaviors (substance use, sexual risk, and medication adherence) in a multi-site sample of youth living with human immunodeficiency virus (HIV) in five U.S. cites.
Youth (N=352) were recruited from four Adolescent Trials Network (ATN) sites (Philadelphia, Fort Lauderdale, Baltimore, and Los Angeles) and one non-ATN site in Detroit and screened for multiple problem behaviors for an intervention study. A substance abuse problem was determined with the CRAFFT, a six-item adolescent screener. Single items were used to screen for current sexual risk and for an HIV medication adherence problem. Of the youth, 239 (68%) had at least one of the three risk behavior problems based on the screener. A total of 186 (52.8%) completed longer, in-depth questionnaires for each problem behavior.
Of the 352 youth screened, 60% had problem level substance use and 42% had a sexual risk problem. Of the 165 (47%) who were prescribed medications, 91 (55%) reported an adherence problem. A total of 112 (32%) reported no problem behavior, 123 (35%) reported 1 problem behavior, 95 (27%) reported 2 problem behaviors, and 20 (6%) reported 3 problem behaviors. Males were more likely to have a substance use problem. Younger youth living with HIV and those perinatally infected were more likely to have an adherence problem. Among the 186 (52.8%) completing longer measures, those with a substance abuse problem had higher substance use on a timeline follow-back procedure than those without. Participants who screened positive for a sexual risk problem reported more unprotected sex on an in-depth interview than those without. Those who screened positive for an adherence problem had higher viral loads than those without an adherence problem.
Results suggest high rates of problem behaviors among youth living with HIV, particularly in older youth. Younger and perinatally infected youth may require specialized adherence interventions. Associations between the screener and more in-depth assessment measures suggest potential clinical utility of screening youth for high-risk behaviors.
描述在美国五个城市中，一个多地点的、感染人类免疫缺陷病毒（HIV）的青年群体中的多重风险行为（药物滥用、性风险和药物依从性）。
从四个青少年试验网络（ATN）站点（费城、劳德代尔堡、巴尔的摩和洛杉矶）和一个非 ATN 站点（底特律）招募了 352 名青年，对他们进行了一项干预研究，以筛选出多种问题行为。使用 CRAFFT 对药物滥用问题进行了六项目筛查。使用单项指标来筛查当前的性风险和 HIV 药物依从性问题。在这些青年中，根据筛查结果，有 239 人（68%）至少存在三种风险行为问题中的一种。共有 186 人（52.8%）完成了对每种问题行为的更长、更深入的问卷。
在接受筛查的 352 名青年中，60%存在药物使用问题，42%存在性风险问题。在 165 名（47%）接受药物治疗的青年中，有 91 人（55%）报告存在药物依从性问题。共有 112 人（32%）报告没有问题行为，123 人（35%）报告有 1 种问题行为，95 人（27%）报告有 2 种问题行为，20 人（6%）报告有 3 种问题行为。男性更有可能存在药物使用问题。感染 HIV 的年轻青年和经母婴垂直传播感染 HIV 的青年更有可能存在药物依从性问题。在完成更长测量的 186 名参与者中，在时间线回溯程序中，有药物滥用问题的参与者的药物使用量高于没有该问题的参与者。在筛查出有性风险问题的参与者中，在深入访谈中报告的无保护性行为多于没有该问题的参与者。在筛查出药物依从性问题的参与者中，病毒载量高于没有该问题的参与者。
结果表明，感染 HIV 的青年中存在高比率的问题行为，尤其是在年长的青年中。年龄较小和经母婴垂直传播感染 HIV 的青年可能需要专门的药物依从性干预措施。筛查工具与更深入的评估工具之间的关联表明，对青年进行高危行为筛查具有潜在的临床应用价值。
