A cluster randomized trial of community mobilization to reduce methamphetamine use and HIV risk among youth in Thailand: Design, implementation and results.
Soc Sci Med
; 211: 216-223, 2018 08.
Article
en En
| MEDLINE
| ID: mdl-29966816
ABSTRACT
BACKGROUND:
Use of methamphetamines (MA) and other stimulants have consistently been associated with HIV/STI risk globally. We evaluated a community mobilization intervention (Connect to Protect, C2P®) to prevent MA use among youth and reduce HIV risk behaviors through community structural changes.DESIGN:
A community-randomized trial in northern Thailand with matched districts randomized to C2P intervention or a standard voluntary counseling and testing (VCT) control. Intervention districts formed stakeholders' coalitions to plan tailored local prevention programs. Two independent random household samples of youth aged 14-24 were surveyed in 2009 and 2012. Lifetime and recent MA use was modeled with multilevel logistic regression.RESULTS:
Intervention initiatives included family-strengthening programs, school-based programs and opening a community drug treatment center. Control communities applied the government-led "war on drugs" approach in addition to youth and family programs. Baseline (Nâ¯=â¯1077) and follow-up (Nâ¯=â¯1225) samples included 47.5% females and 21.7% aged ≤16. Lifetime MA use in intervention districts reduced from 13.4% to 11.7% compared to reduction from 16.2% to 10.4% in the control districts (non-significant). In models, lifetime MA use was associated with time (aORâ¯=â¯0.6, 95%CI 0.38-0.83), females (aORâ¯=â¯0.2, 95%CI 0.15-0.29), increasing age (aORâ¯=â¯2.4, 95%CI 1.40-4.20, ages 16-19; aORâ¯=â¯3.5, 95%CI 2.00-6.12, ages ≥20), and not being full-time students (aORâ¯=â¯5.3, 95%CI 3.77-7.37). Recent MA use showed similar results. Additionally, lifetime MA use was significantly associated with alcohol use, risky sexual behaviors and elevated depressive symptoms.CONCLUSIONS:
Delay in developing and implementing specific prevention programs in the intervention districts slowed diffusion of the effect into the communities. Secular trends with contentious civil unrest and active drug-enforcement efforts in the control communities also contributed to the null intervention effect. Longer time and intensified efforts stressing a public health approach are needed to demonstrate the effectiveness of community mobilization in reducing substance use and HIV risk in this rural Thai community.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Participación de la Comunidad
/
Trastornos Relacionados con Sustancias
/
Metanfetamina
Tipo de estudio:
Clinical_trials
/
Etiology_studies
País/Región como asunto:
Asia
Idioma:
En
Revista:
Soc Sci Med
Año:
2018
Tipo del documento:
Article