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

项目摘要/摘要 青少年人类免疫缺陷病毒(HIV)和抑郁症是公共卫生面临的重大挑战 对于南非来说，这是一个全球艾滋病毒流行最严重的国家，包括VIO在内的结构性因素- 伦斯和贫穷增加了心理健康状况不佳的易感性。在已经经历了心理上的家庭 痛苦，青少年面临包括艾滋病毒和抑郁症在内的性传播感染(STI)的风险增加- 西翁。在青春期，当艾滋病毒、性传播感染和抑郁症的风险- 锡安呈指数增长。针对青少年的预防干预战略应实质上包括 能够定制预防内容以满足青少年个人独特需求的家庭，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HIV/STI危险行为和抑郁的保护因素，强调了家庭干预的必要性 发明方法。然而，在家庭预防科学方面存在重大差距。在南非，很少有人在经验上超过- 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结合起来。我们的复原力-或者- ENTED方法使家庭参与预防面临高度逆境的低资源环境中的青少年。 我们专注于青少年(14-16岁)，他们正处于家庭参与的理想发展过渡阶段- 预防方面的措施。我们为年龄和发展量身定做的干预措施--称为我们的家庭我们的未来--是 基于两种经验支持的干预措施，这两种干预措施已经整合并适应南非。在……里面 作为一项试点随机试验，我们的家庭我们的未来显示出出色的可接受性、可行性和前景 效果的方向，包括减少抑郁症状；较低的性行为比率；减少无保护措施 性行为；增加艾滋病毒检测；提高预防艾滋病毒/性传播感染的知识、动机、意图和自我效能 行为；改善家庭互动；提高复原力。现在我们提出下一阶段的重新- 我们的家庭我们的未来的有效性研究-搜索计划有三个目的：(1)测试Our的有效性 预防青少年(14-16岁)HIV/STI感染的家庭和未来干预措施 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名青少年随机分配到我们的家庭，我们的未来干预或通常的护理，为期6个月和12个月- 来自评估；(2)检查我们的家庭我们的未来干预的影响程度) 受韧性变化的影响；行为技能；关于性、避孕套使用、性别的规范和态度； 和家庭沟通和功能，以及b)受社会人口统计、家庭艾滋病毒、 和社会保护；(3)确定障碍和促进者，以便在 以社区为基础的大型组织环境，具有广泛的覆盖面，为未来的传播和 放大。这项研究填补了在重点人群和环境中家庭预防科学的一个重大空白，并 与艾滋病毒、NIMH、NIAID和NICHD战略研究优先事项的跨NIH计划保持一致。

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.