The proposed study is the first randomized controlled trial (RCT) adapting an evidence-based HIV and substance use prevention intervention for most at-risk adolescents and their caregivers (parents or other adult family members) from drug-risk communities in Kazakhstan. Located on major drug trafficking routes, Central Asia and Kazakhstan, in particular, are experiencing one of the fastest growing rates of HIV infection in the world, disproportionately affecting young people. Youth exposed to drugs at home and in the community are particularly at risk. A quarter of at-risk youth in Kazakhstan initiates sexual or substance use risk behaviors between the ages 15-17, making it a crucial stage for prevention. The country's HIV prevention efforts are limited to a knowledge-based approach, which does not equip at-risk youth with skills required to deal with situations of risk exposure. Parents or other caregivers, who represent a significant protective force in a family- oriented culture of Central Asia, are largely excluded from youth prevention efforts in Kazakhstan. In response to PA-09-146, the proposed study will adapt and test the feasibility and estimate the effect size parameters of Kazakhstani Family Together (KFT), a family-based multi-media intervention designed to reduce sexual and drug-related risks for HIV infection among at-risk 15-17 year old females and males living in communities highly affected by heroin trade and use in Almaty, Kazakhstan. To address the dual risk of HIV and substance use, the proposed intervention combines empirically tested skills-based and family involvement approaches and utilizes multi-media computer technology to develop an engaging and potentially cost-effective tool with high fidelity and easy scalability. The US/Kazakhstani investigative team will conduct formative research and will work closely with the Community Collaborative Board to adapt the intervention to the cultural context of at-risk families in Kazakhstan. The KFT intervention will be tested in a pilot RCT with 144 adolescents and 144 of their caregivers. Intervention arm adolescent-caregiver pairs will receive four 45- minute interactive multi-media sessions with avatars customized to participants'ethnicity and gender that will focus on risk reduction self-efficacy, resistance to peer pressure, and caregiver-adolescent communication, support and monitoring. Adolescents from both intervention and control arms will receive the usual care services available for at-risk youth, which includes health education sessions on HIV and drug use delivered by peer educators and outreach workers. To inform a larger efficacy trial, the proposed pilot feasibility study will provide estimates of recruitment, attrition, intervention fidlity, youths'and caregivers'levels of participation and satisfaction with the intervention and preliminary estimates of effects on adolescents'sexual and substance use-related outcomes (current sexual activity, unprotected sex, current use of alcohol or drugs). The study will be led by an investigative team from Columbia University Global Health Research Center of Central Asia (PI: Dr. Ismayilova) in collaboration with local partners providing services to at-risk youth.
The study will contribute to the development of a culturally and gender congruent computerized HIV prevention intervention integrating skills-based and family-involvement approaches to prevent sexual risk taking and substance use among at-risk adolescents in Kazakhstan. Adapting a theory-driven, easily scalable, and engaging evidence-based multimedia intervention for at-risk youth from drug-risk communities will have a significant public health impact in reduction of sexual and drug-related HIV risk behaviors in the Central Asian region that has been hit hard by wide access to cheap drugs, high alcohol consumption, and one of the highest growth rates of HIV infection in the world, disproportionately affecting young people.