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.

项目总结/摘要 青少年人体免疫缺陷病毒（艾滋病毒）和抑郁症是重大的公共卫生挑战 南非是全球艾滋病疫情最严重的国家，在那里， 冷漠和贫穷增加了精神健康不佳的可能性。在已经经历心理疾病的家庭中， 青少年面临着包括艾滋病毒和抑郁症在内的性传播感染的风险增加， 锡永。在青春期迫切需要预防性干预措施，因为艾滋病毒、性传播感染和抑郁症的风险- 锡永指数增长。青少年的预防性干预策略应包括： 家庭可以定制预防内容，以满足个别青少年的独特需求，并加强 预防行为的形成和习惯化。此外，有证据表明，共同的家庭风险和亲- 青少年艾滋病毒/性传播感染风险行为和抑郁症的保护因素，强调需要一个家庭预防， 预防方法。然而，在家庭预防科学方面存在重大差距。在南非，很少有经验上的支持- 移植的家庭干预措施将预防艾滋病毒/性传播感染与青少年抑郁症结合起来。我们的服从- 有针对性的方法让家庭参与到面临严重逆境的低资源环境中的青少年预防工作中。 我们专注于处于家庭参与理想发展过渡期的青少年（14-16岁）- 在预防方面。我们的年龄和发展量身定制的干预-称为我们的家庭我们的未来-是 基于两个经验支持的干预措施，这些干预措施已被整合并适应南非。在 一项试点随机试验，我们的家庭我们的未来表现出突出的可接受性，可行性和有前途的 影响的方向，包括减少抑郁症状;降低性生活率;减少无保护措施 性;增加艾滋病毒检测;增加对艾滋病毒/性传播感染的保护性知识、动机、意图和自我效能 行为;改善家庭互动;提高弹性。现在我们建议下一阶段的改革- 搜索程序，我们的家庭我们的未来的功效研究有三个目的：（1）测试我们的功效 家庭我们未来的干预措施，预防青少年（14-16岁）感染艾滋病毒/性传播感染， 通过减少艾滋病毒/性传播感染的危险行为，减少抑郁症状。该项目将 将N=880名青少年随机分配至Our Family Our Future干预组或常规护理组，为期6个月和12个月， （2）审查"我们的家庭我们的未来"干预措施的影响程度a） 由弹性变化介导;行为技能;与性、避孕套使用、性别相关的规范和态度; 和家庭沟通和功能，以及B）受社会人口统计学，家庭艾滋病毒， （3）确定在一个国家范围内实施“我们的家庭我们的未来”的障碍和促进因素。 以社区为基础大型组织，范围广泛，可为今后的传播提供数据， 按比例放大。这项研究填补了家庭预防科学在优先人群和环境中的重大空白， 与国家卫生研究院关于艾滋病毒、NIMH、NIAID和NICHD战略研究优先事项的跨国家卫生研究院计划保持一致。