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

• Passetti, L. L., Garner, B. R., Funk, R.,
• Godley, S. H., Godley, M. D.
• Chestnut Health Systems
• JMATE 2008

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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).

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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)

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HIV Risk in Adolescents Presenting to Substance
Abuse Treatment
Sexual activity at early age Injection drug use
Unprotected sex Sex with injection drug users
Multiple partners Victimization
Sex under the influence Multiple risk behaviors
(Ammon et al., 2005 Deas-Nesmith et al., 1999
Jainchill et al., 1999 Malow et al., 2001
Tapert et al., 2001)
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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
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Sample

• 283 adolescents
• Strengthening Communities - Youth (SCY)
• n113
• Admitted to outpatient substance abuse treatment
• Assertive Continuing Care (ACC-2)
• n170
• Admitted to residential substance abuse treatment

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Participant Characteristics at Intake (n283)

• 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

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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

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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
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Analysis

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

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Unit of Analysis

• 283 adolescents
• 477 observations in which adolescents reported at
  least one risk factor for HIV infection

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Predictors

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

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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

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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

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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)

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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
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ResultsUnivariate Logistic Regression
Odds Ratio 95 CI p
Intake Variables
Age 0.83 (0.71, 0.99) 0.03
Female 0.72 (0.48, 1.07) 0.11
Minority 0.99 (0.65, 1.50) 0.96
Years of Education 0.82 (0.71, 0.94) 0.01
Symptoms of internalizing disorder 0.80 (0.55, 1.18) 0.26
Symptoms of externalizing disorder 1.37 (0.90, 2.08) 0.15
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ResultsUnivariate Logistic Regression
Odds Ratio 95 CI p
Follow-up Variables
In School 1.15 (0.77, 1.71) 0.50
Employed 0.87 (0.59, 1.27) 0.47
Involved with CJS 1.82 (0.87, 1.90) 0.22
Substance Frequency Scale 0.83 (0.69, 0.98) 0.03
Substance Problem Scale 0.81 (0.68, 0.97) 0.21
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ResultsUnivariate Logistic Regression
Odds Ratio 95 CI p
Follow-up Variables
Recovery Environment Risk Index 0.82 (0.67, 0.99) 0.03
Social Risk Index 0.79 (0.65, 0.97) 0.02
Treatment Motivation Index 1.00 (0.82, 1.23) 0.99
Treatment Resistance Index 0.79 (0.66, 0.95) 0.01
Problem Orientation Scale 0.90 (0.73, 1.09) 0.28
Weeks in SA Treatment 1.10 (1.06, 1.51) 0.00
Weeks in MH Treatment 1.02 (0.99, 1.04) 0.07
Weeks in a Controlled Environment 1.09 (0.99, 1.19) 0.06
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Results Multivariate Mixed Nominal Regression
ß Odds Ratio 95 CI p
Intercept 1.65
Age -1.95 0.79 (0.63, 1.00) 0.05
Recovery Environment Risk Index -2.10 0.78 (0.62, 0.98) 0.04
Treatment Resistance Index -2.12 0.79 (0.64, 0.98) 0.03
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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

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Strengths

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

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Limitations

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

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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

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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