HIV infection is a global pandemic shaped by local conditions, cultural and behavioral norms and practices. HIV risk behavior intervention research in a resource-poor setting is scarce and studies in HIV+ youth in this setting are non-existent.
The specific aim of the application is to design and pilot test a culturally-sensitive and theoretically-driven Motivational Enhancement Therapy (MET) to reduce sexual risks, our primary focus, in HIV+ youth in Thailand. MET is a structured, manualized intervention combining motivational elements with cognitive-behavioral techniques based on the Information-Motivation-Behavior Skills Model. This project is significant because it addresses a critical international public health issue related to HIV+ youth, and will help us better understand the risk behaviors of HIV+ Thai youth. It will demonstrate the effect size and initial efficacy of MET and how to adapt MET in a different sociocultural setting. The results may have an impact on the local public health and may help advancing the care of HIV+ youth in Thailand. We will execute the study in 3 phases in HIV+ Thai youth between 16-24 years of age. Phase I will include translation, modification, feasibility testing and refinement of MET, based on our existing Healthy Choices manual. First, there will be 2 focus group discussions (5 care providers and 5 HIV+ youth) to review the translated Healthy Choices manual for cultural appropriateness. The manual will be revised and pilot-tested in 10 HIV+ youth who will receive 4-session MET over 12 weeks. Each session will be videotaped. Qualitative analyses will be conducted to obtain information on cultural relevance and appropriateness of MET and the barriers and facilitators to health behaviors, we will develop audio computer-assisted self-interview (ACASI) and will administer measures via ACASI at baseline and at 1-month post-intervention. We will interview youth about their experience with MET. The data will guide further refinement of MET and measures for Phase II. In Phase II, we will conduct a pilot randomized trial to assess Effect Size and initial efficacy of MET on sexual risks in 110 youths in 2 study arms, Intervention group (4-session MET) versus Attention Control group (4- session general health education). Four sessions will be completed in 12 weeks. Youth will complete assessments via ACASI at baseline, 1-month post-intervention, and 6-month post-intervention. Phase III will consist of data analysis, initial dissemination activities and the development of an RO1 application. ? ? ? ?
