Our Family Our Future: A resilience-oriented family intervention to prevent adolescent HIV/STI infection and depression in South Africa

我们的家庭我们的未来：以复原力为导向的家庭干预措施，以预防南非青少年艾滋病毒/性传播感染和抑郁症

• 批准号: 10222523
• 负责人: Linda-Gail Gail Bekker
• 金额: $ 59.8万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-11 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222523
• 关键词: 14 year old; 16 year old; AIDS prevention; Address; Adherence; Adolescence; Adolescent; Affect; Age; Attitude; Behavior; Behavioral; Biological Factors; Communication; Communities; Country; Data; Development; Dissemination and Implementation; Distress; Elements; Emotions; Ensure; Environment; Environmental Risk Factor; Epidemic; Epidemiology; Exhibits; Face; Family; Future; Future Generations; Gender; Goals; Government; Grant; HIV; HIV Infections; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Interview; Knowledge; Language; Life; Life Cycle Stages; Link; Major Depressive Disorder; Manuals; Mediating; Mental Depression; Mental Health; Motivation; National Institute of Allergy and Infectious Disease; National Institute of Child Health and Human Development; National Institute of Mental Health; Numbness; Outcome; Outcome Assessment; Parents; Phase; Population; Poverty; Predisposition; Prevalence; Prevention; Prevention approach; Process; Public Health; Randomized; Reporting; Research; Research Priority; Resources; Risk; Risk Behaviors; Risk Factors; STI prevention; Science; Self Efficacy; Severities; Sexual Health; Sexually Transmitted Diseases; Social Protection; South Africa; South African; Standardization; Structure; United States National Institutes of Health; Unsafe Sex; Violence; acceptability and feasibility; adolescent HIV prevention; adolescent health; base; child depression; community engaged research; community setting; condoms; depressive symptoms; design; efficacious intervention; efficacy study; efficacy testing; efficacy trial; emotion dysregulation; emotional experience; experience; family support; food insecurity; habituation; improved; literacy; pilot trial; prevent; preventive intervention; programs; protective behavior; protective efficacy; protective factors; psychological distress; randomized trial; reduce symptoms; resilience; scale up; selective prevention; sex; sexual HIV transmission; sexual risk behavior; skills; social structure; sociodemographics; substance use; treatment as usual

PROJECT SUMMARY/ABSTRACT Adolescent human immunodeficiency virus (HIV) and depression present significant public health challenges for South Africa, a country with the largest HIV epidemic globally and where structural factors including vio- lence and poverty increase susceptibility for poor mental health. In families already experiencing psychological distress, adolescents face elevated risk for sexually transmitted infections (STIs) including HIV and depres- sion. Preventive interventions are urgently needed during adolescence when risks for HIV, STIs, and depres- sion in-crease exponentially. Preventive intervention strategies for adolescents should substantively involve families who can tailor prevention content to meet the unique needs of individual adolescents and reinforce formation and habituation of prevention behaviors. Moreover, evidence indicates common family risk and pro- tective factors for adolescent HIV/STI risk behaviors and depression, underscoring the need for a family pre- vention approach. However, key gaps exist in family prevention science. In South Africa, few empirically sup- ported family interventions integrate prevention of HIV/STI with depression for adolescents. Our resilience-ori- ented approach engages families in adolescent prevention from low-resource settings facing high adversity. We focus on adolescents (14-16 years of age) who are at an ideal developmental transition for family engage- ment in prevention. Our age- and developmentally-tailored intervention – called Our Family Our Future – is based off of two empirically supported interventions that have been integrated and adapted to South Africa. In a pilot randomized trial, Our Family Our Future exhibited outstanding acceptability, feasibility and promising direction of effects including reductions of depressive symptoms; lower rates of sex; decreased unprotected sex; increased HIV testing; increased knowledge, motivation, intentions and self-efficacy for protective HIV/STI behaviors; improved family interactions; and increased resilience. Now we propose the next phase of this re- search program, an efficacy study of Our Family Our Future with three aims: (1) test the efficacy of the Our Family Our Future intervention in preventing HIV/STI acquisition among adolescents (14-16 years of age) with depressive symptoms by reducing HIV/STI risk behavior, and reducing depressive symptoms. The project will randomize N=880 adolescents to Our Family Our Future intervention or usual care with 6- and 12-month out- come assessments; (2) examine the extent to which the impact of the Our Family Our Future intervention is a) mediated by changes in resilience; behavioral skills; norms and attitudes relating to sex, condom use, gender; and family communication and functioning and b) moderated by the effect of sociodemographics, family HIV, and social protections; (3) identify barriers and facilitators to implementing Our Family Our Future within a large community-based organization setting with wide reach to provide data for future dissemination and scale-up. The study fills a significant gap in family prevention science in a priority population and setting and is aligned with the Trans-NIH Plan for HIV, NIMH, NIAID, and NICHD strategic research priorities.

项目摘要/摘要 青春期人类免疫缺陷病毒（HIV）和抑郁症带来了重大的公共卫生挑战 对于南非，一个全球艾滋病毒流行最多的国家，结构性因素包括vio- 借口和贫穷会增加对心理健康不良的敏感性。在已经经历心理的家庭中 困扰，青少年面临性传播感染（STI）的风险较高 锡。当艾滋病毒，性传播感染和de​​pres的风险时，在青少年期间迫切需要进行预防性干预 呈指数性。青少年的预防干预策略应实质性地涉及 可以量身定制预防内容的家庭，以满足各个青少年的独特需求并加强 预防行为​​的形成和习惯。此外，有证据表明家庭风险和促进 青少年艾滋病毒/STI风险行为和抑郁症的涉及因素，强调了对家庭的需求 发条方法。但是，家庭预防科学中存在关键差距。在南非，很少有经验 对青少年的抑郁症和抑郁症的植物家庭干预措施预防。我们的韧性 - 诱人的方法使家庭参与青少年的预防，从广告高的广告中面临的低资源环境。 我们专注于青少年（14-16岁），他们是家庭参与的理想发展过渡 - 预防。我们的年龄和发展规定的干预措施（称我们的家庭我们的未来）是 基于两种紧急支持的干预措施，这些干预措施已融入并适应了南非。在 飞行员随机试验，我们的家庭我们的未来暴露了出色的可接受性，可行性和诺言 影响方向，包括减轻抑郁症状的减轻；性别降低；降低了未受保护 性别;艾滋病毒测试增加；对保护艾滋病毒/STI的知识，动机，意图和自我有效 行为；改善家庭互动；并提高了弹性。现在，我们提出了此重新的下一阶段 搜索计划，对我们家庭的有效研究，我们的未来有三个目标：（1）测试我们的有效性 家庭我们将来的干预措施，以防止青少年（14-16岁）中的艾滋病毒/性传播感染 通过减少艾滋病毒/STI风险行为并减少抑郁症状，抑郁症状。该项目将 随机将n = 880名青少年与我们的家人一起使用，我们将来的干预措施或6个月和12个月的通常护理 来评估； （2）检查我们家庭未来干预的影响程度a） 通过弹性变化介导；行为技巧；与性，避孕套，性别有关的规范和参加； 家庭沟通和功能以及b）受社会人口统计学的影响，家庭艾滋病毒的影响 和社会保护； （3）确定障碍和促进者，以实施我们的家庭在 具有广泛范围的基于社区的大型组织设置，以提供未来传播和 扩展。这项研究填补了优先人口和环境中家庭预防科学的显着空白，是 与HIV，NIMH，NIAID和NICHD战略研究重点的Trans-NIH计划保持一致。