Adaptation and optimization of the Friendship Bench mental health intervention for adolescent girls and young women in South African PrEP delivery settings

摘要 提议的K99/R00奖项的目标是支持Jennifer Velloza博士发展成为独立的 艾滋病毒和精神卫生研究人员，重点是改善精神卫生综合干预措施的提供 为年轻女性提供艾滋病毒预防服务。韦洛扎博士是流行病学家和哈佛大学博士后研究员 华盛顿大学。这份提案概述了一项为期5年的培训和研究计划，以建设她的能力 以人为本的设计和实施科学的正规培训。培训计划：确保过渡到 独立后，Velloza博士组建了一支由具有以下专业知识的导师和顾问组成的多学科团队 南非以人为中心的设计、实施科学、PrEP和精神健康服务交付 青春期女孩和年轻妇女(AGYW)。他们已经制定了一份完善的培训计划，其中包括会议和相关的 课程作业。K99的培训目标是：1)熟练掌握以人为中心的干预设计 适应；2)应用实施科学工具来确定整合心理健康的实施战略 对PrEP分娩的健康干预；以及3)通过领导一项试验来测试和优化 在PrEP环境下对南非AGYW的心理健康干预。这些目标建立在她以前的经验基础上 并培训和支持她的长期职业目标。研究计划：非洲AGYW面临高艾滋病毒和高感染率 常见的精神障碍。PREP是一种高效的艾滋病毒预防方法，正在南方推广 非洲。然而，常见精神障碍的症状是使用PrEP和南方的重大障碍 非洲卫生部越来越重视为AGYW提供PrEP的分层方法。 有效的心理健康治疗，如问题解决疗法(PST)，有可能与 准备交付以解决心理健康挑战和PrEP使用的可修改障碍并改进PrEP 坚持AGYW。友谊长椅是AGYW基于证据的PST干预方案 在PrEP环境中，鉴于它是为繁忙的艾滋病毒诊所提供而开发的，目前正在南方扩大规模 非洲，初步数据表明，可以对其进行调整，以提高非洲人对艾滋病毒治疗的依从性 女人。需要研究调整干预内容，评估心理健康和PrEP的有效性 遵守结果，并确定AGYW在PrEP交付环境中的实施战略。整体而言 这项提议的目标是调整、测试和优化非洲AGYW在PrEP交付方面的友谊长凳。 具体目标是：1)确定心理健康干预的内容和实施的障碍 预备诊所；2)设计和试点青年友谊长椅SA的内容和实施战略；3)开展 一项评估青年友谊长凳SA对PrEP依从性的初步效果的混合型II试验 针对PrEP交付中的成本约束优化实施；以及4)确定有关干预的主题 经历。这些目标与Velloza博士的培训目标相一致，她将成为一个独立的 致力于精神健康和艾滋病毒预防服务提供方面的高度优先问题的科学家。

ABSTRACT The goal of the proposed K99/R00 award is to support Dr. Jennifer Velloza’s development into an independent HIV and mental health researcher, with a focus on improving delivery of mental health interventions integrated with HIV prevention services for young women. Dr. Velloza is an epidemiologist and postdoctoral fellow at the University of Washington. This proposal outlines a 5-year training and research plan to build her capacity with formal training in human-centered design and implementation science. Training Plan: To ensure transition to independence, Dr. Velloza has assembled a multidisciplinary team of mentors and advisors with expertise in human-centered design, implementation science, and PrEP and mental health service delivery for South African adolescent girls and young women (AGYW). They have crafted a robust training plan with meetings and relevant coursework. The training goals for the K99 are to: 1) Gain proficiency in human-centered design for intervention adaptation; 2) Apply implementation science tools to identify implementation strategies for integrating a mental health intervention in PrEP delivery; and 3) Transition to independence by leading a trial to test and optimize a mental health intervention for South African AGYW in PrEP settings. These goals build on her prior experience and training and support her long-term career goals. Research Plan: African AGYW face high rates of HIV and common mental disorders. PrEP is a highly effective HIV prevention approach which is being scaled up in South Africa. However, symptoms of common mental disorders are significant barriers to PrEP use and the South African Department of Health is placing increasing emphasis on layered approaches to PrEP delivery for AGYW. Effective mental health treatment, such as problem-solving therapy (PST), has the potential to be integrated with PrEP delivery to address mental health challenges and modifiable barriers to PrEP use and improve PrEP adherence for AGYW. The Friendship Bench is a promising evidence-based PST intervention option for AGYW in PrEP settings given that it was developed for delivery in busy HIV clinics, is currently being scaled-up in South Africa, and preliminary data suggests it can be adapted to improve HIV treatment adherence among African women. Research is needed to adapt intervention content, evaluate effectiveness on mental health and PrEP adherence outcomes, and identify implementation strategies for AGYW in PrEP delivery settings. The overall goal of this proposal is to adapt, test, and optimize the Friendship Bench for African AGYW in PrEP delivery. The Specific Aims are to: 1) Identify content for a mental health intervention and barriers to implementation in PrEP clinics; 2) Design and pilot Youth Friendship Bench SA content and implementation strategies; 3) Conduct a hybrid Type II trial to assess preliminary effectiveness of Youth Friendship Bench SA on PrEP adherence while optimizing implementation for cost constraints in PrEP delivery; and 4) Identify themes around intervention experiences. These aims correspond with Dr. Velloza’s training goals and she will emerge as an independent scientist contributing to high priority issues around mental health and HIV prevention service delivery.