Feasibility of a Multimedia Drug Abuse Prevention Intervention for at-Risk Adolescents and Their Caregivers in Kazakhstan

Introduction:Located on the major drug trafficking route from Afghanistan, Kazakhstan is experiencing one of the fastest growing rates of HIV infection in the world, disproportionately driven by injection drug use. The country’s HIV and drug abuse prevention efforts are limited to knowledge-based programs at schools that do not target at-risk adolescents and do not equip them with skills required to deal with situations of risk exposure. Furthermore, family members, who represent a significant protective force in a family-oriented culture of Central Asia, are largely excluded from youth prevention efforts in Kazakhstan.

Methods: We use data from the NIDA-funded pilot RCT testing the feasibility 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 14-17 year old adolescents living in communities highly affected by heroin trade and use in Almaty, Kazakhstan. The intervention was culturally adapted through qualitative research and collaboration with youth and expert community advisory boards. The pilot RCT included 180 adolescents recruited through police officers (inspectors) in local schools, together with 180 of their caregivers (parents or other adult family members). Eligible youth had to have at least one risk factor (i.e., substance-using friends or family members, parental criminal history). In addition to the standard school-based health education program on drug use and HIV, intervention arm adolescent-caregiver dyads received three 45-minute interactive multi-media sessions with avatars customized to participants’ gender covering the following topics: risk reduction self-efficacy, resistance to peer pressure, and caregiver-adolescent communication, support and monitoring.

Results: Out of the total sample, 75% of youth participants were boys and 56% of participants were ethnic Russians. Twenty percent of adolescents had a substance-using parent, 32% have been offered to use drugs, 9% had drug-using friends, 22% were in trouble with the police and 34% planned or tried to run away from home. Among participating caregivers, 54% were mothers, 17% were grandmothers and the rest were other relatives (e.g., cousins, adult siblings), when the primary caregiver had problems with drugs or alcohol. About 92% of families completed all thee sessions. The study discusses participant satisfaction, perceived usefulness and usability of the multi-media program.

Conclusions: The study offers strategies for adapting intervention content and delivery techniques to a new population and cultural milieu. The study findings improve scientific knowledge about the tailoring and delivery of culturally adapted drug abuse prevention programs for at-risk youth in international settings. In low resource countries like Kazakhstan, interventions utilizing interactive technologies represent a potentially engaging and cost-effective tool with high fidelity and easy scalability.