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Predictors of Change in HIV Risk Factors for Adolescents Admitted to Substance Abuse Treatment

Predictors of Change in HIV Risk Factors for Adolescents Admitted to Substance Abuse Treatment

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Predictors of Change in HIV Risk Factors for Adolescents Admitted to Substance Abuse Treatment

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  1. Predictors of Change in HIV Risk Factors for Adolescents Admitted to Substance Abuse Treatment Passetti, L. L., Garner, B. R., Funk, R., Godley, S. H., & Godley, M. D. Chestnut Health Systems JMATE 2008

  2. Acknowledgements Preparation of this presentation was supported by funding from the following sources: • Center for Substance Abuse Treatment (Strengthening Communities-Youth project grant no. TI 13356) • National Institute on Drug Abuse (grant no. DA 018183) • National Institute on Alcohol Abuse and Alcoholism (grant no. AA 010368).

  3. HIV Infection in Adolescents • Estimated 5,322 adolescents living with AIDS in the U.S. • 46.7% increase since 2001 (CDC, 2005) • Average of 10 years from HIV infection to development of AIDS • Many young adults likely infected as teenagers (National Institute of Allergy and Infectious Disease, 2000)

  4. HIV Risk in Adolescents Presenting to Substance Abuse Treatment • (Ammon et al., 2005; Deas-Nesmith et al., 1999; Jainchill et al., 1999; Malow et al., 2001; Tapert et al., 2001)

  5. Purpose • For adolescents admitted to substance abuse treatment, identify variables that most strongly predict the transition from: Presence of any HIV risk factor Absence of HIV risk factors Follow-up Interview Next Follow-up Interview

  6. Sample • 283 adolescents • Strengthening Communities - Youth (SCY) • n=113 • Admitted to outpatient substance abuse treatment • Assertive Continuing Care (ACC-2) • n=170 • Admitted to residential substance abuse treatment

  7. Average Age: 16 Caucasian: 70% Male: 65% Main substances of choice: marijuana, alcohol Average years of education: 9 In school: 83% Employed: 39% Involved with criminal justice system: 78% Participant Characteristics at Intake (n=283)

  8. Measurement • Global Appraisal of Individual Needs (GAIN) • Administered at intake and quarterly follow-up intervals • 3, 6, 9, and 12 months post-intake for SCY • 3, 6, 9, and 12 months post-discharge for ACC-2 • Follow-up rates ranged from 90% to 96%

  9. Analysis • Step One - Univariate logistic regression • Identify variables that predict the transition from: (i.e., from 3 to 6 months, 6 to 9 months, 9 to 12 months) Presence of any HIV risk factor Absence of HIV risk factors Follow-up Interview Next Follow-up Interview

  10. Analysis • Step Two - Multivariate mixed nominal regression • Identify strongest predictors of transition • Enter significant predictors from univariate analysis simultaneously

  11. Unit of Analysis • 283 adolescents • 477 observations in which adolescents reported at least one risk factor for HIV infection

  12. Predictors • Intake Variables • Age • Gender • Minority (Yes/No) • Years of education • Symptoms of internalizing disorder (Yes/No) • Symptoms of externalizing disorder (Yes/No)

  13. Predictors • Follow-up Variables (During the past 90 days) • In school (Yes/No) • Employed (Yes/No) • Involved with the criminal justice system (Yes/No) • Substance Frequency Scale (SFS) – 8 items • Substance Problem Scale (SPS) – 16 items • Recovery Environment Risk Index (RERI) – 13 items

  14. Predictors • Follow-up Variables (During the past 90 days) • Social Risk Index (SRI) – 6 items • Treatment Motivation Index (TMI) – 5 items • Treatment Resistance Index (TRI) – 4 items • Problem Orientation Scale (POS) – 5 items • Weeks in substance abuse treatment • Weeks in mental health treatment • Weeks in a controlled environment

  15. Outcome Measure • HIV Risk Status (Yes/No) • Endorsed any of the following HIV risk factors during the past 90 days: • Needle use • Sex with a needle user • Sex while adolescent or partner was high on alcohol or drugs • Unprotected sex • Multiple sex partners (two or more) • Trading sex for drugs/money • Victimized (sexually, physically, or emotionally)

  16. Transition Period: 3 to 6 months Presence 67% Presence (n = 117) Absence 33% HIV Risk Status: 3 Months HIV Risk Status: 6 Months

  17. Transition Period: 6 to 9 months Presence 71% Presence (n = 174) Absence 29% HIV Risk Status: 6 Months HIV Risk Status: 9 Months

  18. Transition Period: 9 to 12 months Presence 61% Presence (n = 186) Absence 39% HIV Risk Status: 9 Months HIV Risk Status: 12 Months

  19. ResultsUnivariate Logistic Regression

  20. ResultsUnivariate Logistic Regression

  21. ResultsUnivariate Logistic Regression

  22. Results Multivariate Mixed Nominal Regression

  23. Conclusions • In this sample, the strongest predictors of transitioning to the absence of any HIV risk factors were: • Younger age • Lower recovery environment risk • Lower treatment resistance

  24. Strengths • Few studies examining change in HIV risk factors over time • Adolescents in OP and residential treatment • High follow-up rates

  25. Limitations • Self-report • No measure of HIV risk interventions received during or after treatment

  26. Implications • Interventions with this population may be developed and tested that are tailored by: • Age • Level of risk in the recovery environment • Level of treatment resistance

  27. Implications • While 1/3 of the analyzed transitions demonstrated improvement in HIV risk, 2/3 represented the same or greater levels of risk • Longer and/or repeated assessments and interventions may be required to initiate and sustain a reduction in HIV risk