Suubi4Her: A Combination Intervention Addressing HIV Risk Behaviors Among Older Adolescent Girls Transitioning into Adulthood in Uganda

与国家卫生研究院解决艾滋病毒新感染差异的优先事项和艾滋病规划署的呼吁保持一致， 实施艾滋病毒预防方法的组合，拟议的研究将审查影响和成本 与Suubi 4 Her相关，这是一种创新的联合干预措施，旨在预防 艾滋病病毒危险行为 在乌干达，生活在受贫穷和艾滋病毒/艾滋病严重影响的社区的15-17岁女孩中，在亚- 在撒哈拉非洲（SSA），家庭经济压力可能会影响对青少年的支持， 生活在贫困中的人表现出较高的危险性行为，增加了他们感染艾滋病毒的脆弱性 和其他性传播感染。与此同时，内化心理健康障碍，如抑郁症和低自我， 自尊不成比例地影响女孩，并可能导致艾滋病毒的危险行为。在这种背景下， 要成功地帮助撒哈拉以南非洲的少女，除了健康教育和性教育之外，还需要提供更多的支持 过渡到年轻的成年。拟议的研究是由两个先前测试的干预-资产- 基于配对储蓄账户（YDA）和通过多家庭小组（MFG）加强家庭 这些方案已成功地在年龄较小的小学生中实施。Suubi 4 Her将 检验年轻人认知和行为变化受经济稳定影响的理论 一边检查 如果需要加强家庭内部的支持和沟通来保持积极的行为健康， 功能和加强参与保护健康的行为。在42所中学内嵌套 在乌干达受艾滋病毒/艾滋病严重影响的四个地区，1260名年龄较大的女孩（入学时年龄为15-17岁）将 随机分配（在学校一级）到三个研究条件之一：1）储蓄（青年发展 教育和微型企业发展账户（YDA）-1：1的激励匹配率; 2）储蓄 (YDA)+ MFG干预; 3）接受标准健康和性教育的控制条件， 学校干预将持续24个月。基线、12、24和36个月时的评估将 包括生物医学数据，以衡量我们主要性风险结果：（1）女孩的生物学 确认的性传播感染（淋病，滴虫和衣原体）;和次要结果：2）新的比例 研究期间的HIV感染，以及3）对于HIV+女孩，病毒载量和CD 4作为ART依从性的标志。 本研究的目的是：1）检验Suubi 4 Her干预是否有效地保护青少年 （c）帮助女孩消除已知的艾滋病毒风险因素（包括出于经济动机的性暴力和亲密伴侣暴力）。（二） 阐明Suubi 4 Her干预对行为健康功能的影响（即，抑郁症，自我- 有效性和绝望），并检查这些变量的影响，作为潜在的变化机制， 调解每项干预措施与减少艾滋病毒风险之间的关系。3)评价其成本效益 每一个干预条件。这项研究还将使用儿童抑郁指数和贝克绝望指数 量表，以检查干预措施在改善这一弱势群体的心理健康的有效性。

Aligned with the NIH priority of addressing disparities in new HIV infections and the UNAIDS call for implementing combination HIV prevention approaches, the proposed study will examine the impact and cost associated with Suubi4Her, an innovative combination intervention that aims to prevent HIV risk behaviors among 15-17 year-old girls living in communities heavily affected by poverty and HIV/AIDS in Uganda. In sub- Saharan Africa (SSA), family financial stress can compromise the support available to adolescents, with girls living in poverty exhibiting higher rates of risky sexual behavior increasing their vulnerability in acquiring HIV and other STIs. At the same time, internalizing mental health disorders such as depression and low self- esteem disproportionately affect girls and may be contributing to HIV risk behavior. Against that backdrop, support over and above health and sex education is needed to help adolescent girls in SSA successfully transition into young adulthood. The proposed study is informed by two previously tested interventions – asset- based matched savings accounts (YDA) and family strengthening through Multiple Family Groups (MFG) which have successfully been implemented with younger primary school-going adolescents. Suubi4Her will test the theory that youth cognitive and behavioral change is influenced by economic stability while examining if enhanced intra-familial support and communication are needed to maintain positive behavioral health functioning and reinforce engagement in protective health behaviors. Nested within 42 secondary schools across four districts of Uganda heavily impacted by HIV/AIDS, 1260 older girls (ages 15-17 at enrollment) will be randomly assigned (at school level) to one of three study conditions: 1) Savings (Youth Development Accounts - YDA)- with a 1:1 incentive match rate – for education and microenterprise development; 2) Savings (YDA) + MFG intervention; 3) Control condition receiving standard health and sex education provided in schools. The intervention will be provided for 24 months. Assessments at baseline,12, 24, and 36-months will include biomedical data to measure our primary sexual-risk outcome:1) proportion of girls' biologically confirmed STIs (Gonorrhea, Trichomonas and Chlamydia); and secondary outcomes: 2) the proportion of new HIV infections during the study period, and 3) for HIV+ girls, viral load and CD4 as markers of ART adherence. The study aims are to: 1) Examine whether the Suubi4Her intervention is effective in protecting adolescent girls against known HIV risk factors (including economically-motivated sex and intimate partner violence). 2) Elucidate the effects of the Suubi4Her intervention on behavioral health functioning (i.e., depression, self- efficacy and hopelessness) and examine the effects of these variables as potential mechanisms of change, mediating the relationship between each intervention and HIV risk reduction. 3) Evaluate the cost-effectiveness of each intervention condition. The study will also use the Child Depression Index and Beck Hopelessness Scale to examine the efficacy of interventions in improving mental health in this vulnerable population.