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SYV: A Mental Health Intervention to Improve HIV Outcomes in Tanzanian Youth

SYV：改善坦桑尼亚青年艾滋病毒感染结果的心理健康干预措施

基本信息

批准号：
10375592
负责人：
Dorothy E. Dow
金额：
$ 51.01万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2026-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10375592
关键词：
Acquired Immunodeficiency Syndrome Address Adherence Adolescence Adult Africa African Age Age-Years Anti-Retroviral Agents Behavioral Caregiver support Caregivers Caring Child Chronic Disease Clinic Clinical Trials Cognitive Therapy Complex Consolidated Framework for Implementation Research Coping Skills Data Development Disclosure Disease Disease Outcome Dose Effect Modifiers (Epidemiology)Effectiveness Emotional Epidemic Equation Evidence based intervention Failure Feedback Formulation Foundations Goals HIV HIV Infections HIV-infected adolescents Hair Health Health Professional Health Services Research Hybrids Incidence Individual Infection Informal Social Control Intervention Interview Investments Joints Lead Learning Life Logic Measurement Measures Mediating Mediator of activation protein Medicine Mental Health Mental Health Services Methods Modeling Morbidity - disease rate Outcome Participant Patient Self-Report Persons Pharmaceutical Preparations Pilot Projects Policies Population Positioning Attribute Productivity Public Health RNA Randomized Regulation Reproductive Health Research Research Priority Resource-limited setting Risk Sampling Severities Site Social support Societies Stigmatization Stress Structure Symptoms Tanzania Testing Time Training Trauma United States National Institutes of Health Validation Viral Voice Work Youth acceptability and feasibility age group antiretroviral therapy base comorbidity coping cost cost effectiveness cost-effectiveness ratio design effectiveness evaluation effectiveness implementation trial evidence base experience follow-up high risk population hybrid type 1 design implementation determinants implementation evaluation implementation outcomes improved incremental cost-effectiveness innovation internalized stigma interpersonal therapy intervention effect medication compliance meetings mortality motivational enhancement therapy multidisciplinary novel novel strategies peer physical conditioning pill population health prevent primary outcome resilience sex skills social social stigma standard of care success therapy adherence therapy design transmission process treatment arm treatment group trend trial design young adult

项目摘要

Young people living with HIV (YPLWH, 10-24 years of age) are a growing population that experience unique mental health challenges that may compromise their HIV care. Despite the clear need, few evidence-based mental health interventions exist to address the difficulties faced by this important population. The long-term goal of our research is to provide developmentally appropriate, evidence-based mental health interventions that effectively prevent and treat HIV in young people, especially in low resource settings where the majority of the epidemic occurs. Sauti ya Vijana (SYV, The Voice of Youth), is a novel and innovative group-based mental health and life skills intervention designed with and for Tanzanian YPLWH to address the mental health and life challenges they have described in our prior research. The intervention consists of 10 group sessions (two joint with caregivers) and two individual sessions delivered by trained young adults living with HIV who have successfully transitioned to the adult clinic using a task sharing model that builds local capacity while overcoming the critical shortage of mental health professionals in this setting. SYV incorporates components of Trauma Informed-Cognitive Behavioral Therapy, Interpersonal Psychotherapy, and Motivational Interviewing that during this critical neurodevelopmental period, when foundations of self and social regulation are realized, may prevent or dramatically reduce severity of mental health symptoms. The overall objectives of this proposal are to support positive coping strategies that bolster mental health and lead to improved HIV outcomes among YPLWH. The central hypothesis is that SYV will be effective to improve antiretroviral therapy (ART) adherence and virologic suppression in YPLWH in Tanzania. The rationale for this project is that by targeting mental health, which is strongly associated with medication adherence, we will effectively improve adherence and thereby HIV viral suppression. The central hypothesis will be tested in three aims in a hybrid type-1 effectiveness-implementation trial. The first aim will use an individually randomized group treatment trial design to determine if SYV is effective based on the primary outcome of 10% increase in virologic suppression (HIV RNA <400 copies/mL) among YPLWH in the intervention arm compared to standard of care. The second aim will elucidate the mechanisms by which SYV works and for whom it is most effective by evaluating potential moderators and mediators of the intervention using structure equation modelling. Change in mental health, internal stigma, resilience and coping are hypothesized to mediate the intervention effect, while age, sex, site, and baseline mental health symptoms are hypothesized moderators. The final aim will evaluate implementation determinants and outcomes, including cost effectiveness and sustainability guided by the Consolidated Framework for Implementation Research (CFIR) to identify any implementation differences among sites. This project is significant because it is expected to fill a critical mental health gap in caring for YPLWH in low resource settings with far-reaching implications on individual health (HIV suppression) and population health (preventing transmission of HIV infection to others).

年轻艾滋病毒感染者（YPLWH， 10-24岁）是一个不断增长的群体，其经历是独特的