Rowe Cynthia L, Alberga Linda, Dakof Gayle A, Henderson Craig E, Ungaro Rocio, Liddle Howard A
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.
Department of Psychology, Sam Houston State University, Huntsville, TX.
Fam Process. 2016 Jun;55(2):305-20. doi: 10.1111/famp.12206. Epub 2016 Feb 16.
This study tested a family-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT). A randomized, controlled, two-site community-based trial was conducted with 154 youth and their parents. Drug-involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42-month follow-up period. At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9-month follow-ups. These intervention differences were evident through the 42-month follow-up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. Intensive group-based and family intervention in detention and following release may reduce sexual risk among substance-involved young offenders, and a family-based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.
本研究测试了一种基于家庭的预防人类免疫缺陷病毒（HIV）/性传播感染（STI）的方法，该方法整合于一种经实证支持的针对涉毒青少年罪犯的治疗方案——多维家庭治疗（MDFT）之中。对154名青少年及其父母进行了一项随机对照的双地点社区试验。涉毒青少年在拘留所被招募，随机分配到MDFT组或常规强化服务组（ESAU），并在入组时、3个月、6个月、9个月、18个月、24个月、36个月和42个月随访时进行评估。两组青少年在拘留期间均接受了有组织的HIV/STI预防，MDFT组的青少年在拘留释放后的持续治疗中还接受了基于家庭的HIV/STI预防。两组青少年在两个地点从入组到9个月时无保护性行为发生率和STI发病率均显著降低。在42个月的随访期内，他们的STI发病率仍低于基线水平（10%）。在A地点，入组时性活跃且接受MDFT治疗的青少年在入组到9个月随访期间，与ESAU组的青少年相比，性行为总体频率和无保护性行为次数的减少幅度更大。这些干预差异在42个月的随访中都很明显。在B地点未发现干预对STI发病率或无保护性行为有影响。在拘留期间及释放后进行强化的基于小组和家庭的干预可能会降低涉毒青少年罪犯的性风险，而基于家庭的方法可能会增强对高危人群的干预效果。文中讨论了干预效果的地点差异、研究局限性、临床意义及未来研究方向。
