SYV: A Mental Health Intervention to Improve HIV Outcomes in Tanzanian Youth

感染艾滋病毒的年轻人（YPLWH，10-24岁）是一个不断增长的群体，他们经历着独特的艾滋病毒感染。 心理健康挑战可能会影响他们的艾滋病毒护理。尽管有明确的需求，但很少有基于证据的 为解决这一重要群体所面临的困难，已经采取了心理健康干预措施。长期 我们研究的目标是提供适合发展的、基于证据的心理健康干预措施， 有效预防和治疗青年人的艾滋病毒，特别是在资源匮乏的环境中， 流行病发生。Sauti ya Vijana（SYV，青年之声），是一个新颖和创新的基于群体的心理 与坦桑尼亚YPLWH共同设计的健康和生活技能干预措施，以解决心理健康和生活问题 他们在我们之前的研究中描述的挑战。干预包括10个小组会议（两个联合会议）。 与照顾者）和两个由受过培训的年轻艾滋病毒感染者提供的单独课程， 成功地过渡到成人诊所使用任务分担模式，建立当地的能力，同时克服 在这种情况下，心理健康专业人员的严重短缺。SYV包含创伤组件 信息认知行为疗法、人际心理疗法和动机访谈， 这一关键的神经发育时期，自我和社会调节的基础得以实现， 或显著降低心理健康症状的严重程度。本提案的总体目标是支持 积极的应对策略，加强心理健康，改善青年艾滋病毒感染者的艾滋病毒结果。的 中心假设是SYV将有效改善抗逆转录病毒治疗（ART）依从性和病毒学 在坦桑尼亚对YPLWH的镇压。该项目的基本原理是，通过针对心理健康， 与药物依从性密切相关，我们将有效地提高依从性，从而提高艾滋病毒 镇压中心假设将在三个目标中进行测试，在混合型1的有效性-实施 审判第一个目标将使用个体随机分组治疗试验设计，以确定SYV是否有效 基于主要结局，即病毒学抑制增加10%（HIV RNA <400拷贝/mL）， 与标准治疗相比，干预组中的YPLWH。第二个目标是阐明机制 通过评估潜在的主持人和调解人， 使用结构方程模型进行干预。心理健康、内部耻辱感、复原力和应对方式的变化 被假设为介导干预效果，而年龄，性别，地点和基线心理健康症状 是假想的调节者。最终目标是评估执行决定因素和成果，包括 以实施研究综合框架为指导的成本效益和可持续性 （CFIR），以确定各研究中心之间的任何实施差异。这个项目意义重大，因为预计 填补了在低资源环境中照顾YPLWH的关键心理健康差距，对 个人健康（抑制艾滋病毒）和人口健康（防止艾滋病毒传染给他人）。

Young people living with HIV (YPLWH, 10-24 years of age) are a growing population that experience unique mental health challenges that may compromise their HIV care. Despite the clear need, few evidence-based mental health interventions exist to address the difficulties faced by this important population. The long-term goal of our research is to provide developmentally appropriate, evidence-based mental health interventions that effectively prevent and treat HIV in young people, especially in low resource settings where the majority of the epidemic occurs. Sauti ya Vijana (SYV, The Voice of Youth), is a novel and innovative group-based mental health and life skills intervention designed with and for Tanzanian YPLWH to address the mental health and life challenges they have described in our prior research. The intervention consists of 10 group sessions (two joint with caregivers) and two individual sessions delivered by trained young adults living with HIV who have successfully transitioned to the adult clinic using a task sharing model that builds local capacity while overcoming the critical shortage of mental health professionals in this setting. SYV incorporates components of Trauma Informed-Cognitive Behavioral Therapy, Interpersonal Psychotherapy, and Motivational Interviewing that during this critical neurodevelopmental period, when foundations of self and social regulation are realized, may prevent or dramatically reduce severity of mental health symptoms. The overall objectives of this proposal are to support positive coping strategies that bolster mental health and lead to improved HIV outcomes among YPLWH. The central hypothesis is that SYV will be effective to improve antiretroviral therapy (ART) adherence and virologic suppression in YPLWH in Tanzania. The rationale for this project is that by targeting mental health, which is strongly associated with medication adherence, we will effectively improve adherence and thereby HIV viral suppression. The central hypothesis will be tested in three aims in a hybrid type-1 effectiveness-implementation trial. The first aim will use an individually randomized group treatment trial design to determine if SYV is effective based on the primary outcome of 10% increase in virologic suppression (HIV RNA <400 copies/mL) among YPLWH in the intervention arm compared to standard of care. The second aim will elucidate the mechanisms by which SYV works and for whom it is most effective by evaluating potential moderators and mediators of the intervention using structure equation modelling. Change in mental health, internal stigma, resilience and coping are hypothesized to mediate the intervention effect, while age, sex, site, and baseline mental health symptoms are hypothesized moderators. The final aim will evaluate implementation determinants and outcomes, including cost effectiveness and sustainability guided by the Consolidated Framework for Implementation Research (CFIR) to identify any implementation differences among sites. This project is significant because it is expected to fill a critical mental health gap in caring for YPLWH in low resource settings with far-reaching implications on individual health (HIV suppression) and population health (preventing transmission of HIV infection to others).