A Computerized Family-Focused HIV and Drug Abuse Prevention Program for Adolescents: Results from a Pilot Randomized Clinical Trial 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, parents or other adult 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 aiming to develop and test the feasibility of 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 areas of Almaty, Kazakhstan highly affected by heroin trade and use. The intervention was culturally adapted through qualitative research and collaboration with youth and expert community advisory boards. The study included 180 adolescents recruited through police officers (‘inspectors’) from local schools, together with 180 of their caregivers. 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 risk reduction self-efficacy, resistance to peer pressure, and caregiver-adolescent communication, support and monitoring. Adolescents and caregivers completed ACASI surveys in Russian at baseline, 3-month and 6-month follow-ups.

Results: About 98% of participants participated in all three multi-media sessions. Changes were observed in key mediating factors at the youth level (substance use refusal skills, p=.05) and at the level of child-caregiver interactions (e.g., peer approval by parents, p=.04) and communication about youths’ risk behaviors, p=.002).

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 the context of a concentrated HIV epidemic driven by injection drug use. In middle-income and traditional countries like Kazakhstan, interventions that address the dual risk of HIV and substance use, combine empirically tested skills-based and family involvement approaches, involve extended family networks and utilize interactive technologies may represent a potentially engaging and cost-effective tool with high fidelity and easy scalability.