Exploring the mental health and wellbeing of adolescent parent families affected by HIV in South Africa

非洲的青少年人口(10-19岁；世卫组织，2017年)是世界上增长最快的，预计到2050年将达到4.35亿(联合国，2019年)。因此，青少年的健康对于促进个人潜力和确保区域和子孙后代的繁荣正变得越来越重要，心理健康是青少年健康的一个基本组成部分。青春期精神健康不良对个人和更广泛的社会具有广泛的负面影响(联合国人口基金，2014年)。然而，儿童和青少年的心理健康仍然是一个被忽视的全球健康优先事项。经历过青少年怀孕和艾滋病毒携带者都被发现与心理健康不良有关(Vreeman，2017；Dahman，2019年)。然而，当这两种现象同时发生时，很少有文献(除了候选人的论文)探讨心理健康问题。感染艾滋病毒并受艾滋病毒影响的青少年及其子女是撒哈拉以南非洲区域未来繁荣和艾滋病毒防治工作的核心人群。然而，艾滋病毒携带者和受艾滋病毒影响的青少年父母家庭仍然没有得到充分的研究，因此在干预和预防方面得不到足够的服务。这项研究收集了四部分数据：(I)健康和幸福问卷(包括有效的精神健康措施)，(Ii)育儿问卷(详细说明育儿经历)，(Iii)对儿童认知发展的直接评估，以及(Iv)儿童健康记录。对这些数据的横断面分析(由候选人进行)突出了感染艾滋病毒的青少年母亲的心理健康状况比未感染艾滋病毒的母亲更差，在撒哈拉以南非洲地区，青少年母亲所生孩子的儿童发育得分低于成年母亲，感染艾滋病毒和暴露于艾滋病毒的儿童的发育得分低于未感染艾滋病毒的儿童。这些分析还发现，母亲的创伤后应激与较低的儿童认知发展分数，以及父亲对子女的照顾参与度较低(&lt；20%)之间存在关联。在样本中发现，暴露于暴力和缺乏社会支持与青少年母亲的心理健康状况不佳有关，但需要进行纵向分析才能进一步了解这些发现。拟议的奖学金旨在允许候选人：1。巩固候选人博士学位内的工作，并将这些工作扩展到包括纵向跟踪数据。这些工作将侧重于确定可纳入政策和方案的顺从因素，以改善受艾滋病毒影响的青少年父母(包括母亲和父亲)的心理健康及其子女的发展。这些工作还将促进更好地了解青少年母亲所生子女的父亲的经历(一个经常被忽视的群体)2.编写分析和手稿以供出版和传播3.出席会议和利益攸关方会议，以便进行知识转移和建立网络4.为今后可能开展的合作奠定基础，重点关注撒哈拉以南非洲和高收入国家青少年父母家庭的心理健康，目的是扩大论文和博士后活动5的研究结果的应用范围。开展进一步培训，以培养与方法论有关的技能，并在学术界建立事业6.开发资金申请，以推进作为博士后奖学金一部分开展的工作，并进一步解决数据需求，以便有效地制定有意义的政策和方案，为今世后代服务

Africa's adolescent population (10-19 years; WHO,2017) are the fastest growing the in world - projected to reach 435 million by 2050 (United Nations,2019). Consequently, the health of adolescents, of which mental health is a fundamental component, is becoming increasingly important to promote individual potential, and ensure the prosperity of the region, and future generations. Poor mental health within adolescence has broad negative implications for individuals and wider society (United Nations Population Fund,2014). Yet, the mental health of children and adolescents remains an overlooked global health priority. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with poor mental health (Vreeman,2017; Dahmen,2019). However, there is a dearth of literature (beyond the candidate's thesis) exploring mental health when both phenomena co-occur. Adolescents and their children living with and affected by HIV are a core population in both the future prosperity of the sub-Saharan Africa region and the HIV response. However, adolescent parent families living with and affected by HIV remain understudied, and thus underserved with regard to intervention and prevention.The HEY BABY study is a cohort study of over 1000 adolescent mothers (both living with and not living with HIV) and their children residing in the Eastern Cape province, South Africa. Four components of data are collected within the study: (i) a health and wellbeing questionnaire (including validated mental health measures), (ii) a parenting questionnaire (giving detail on parenting experience), (iii) a direct assessment of child cognitive development, and (iv) child health records. Cross-sectional analyses of these data (undertaken by the candidate) have highlighted elevated poor mental health among adolescent mothers living with HIV compared to mothers not living with HIV, lower child development scores among children born to adolescent mothers compared to adult mothers within the sub-Saharan African region, and lower developmental scores among children living with HIV and HIV exposed uninfected children compared to children unexposed to HIV. These analyses have also identified an association between maternal posttraumatic stress and lower child cognitive development scores, and low paternal engagement within the care of their children (<20%). Violence exposure and lack of social support were found to be correlates of poor mental health among adolescent mothers in the sample, however longitudinal analyses is required to further understand such findings. The proposed fellowships aims to allow the candidate to: 1. Consolidate the works within the candidate's PhD and extending these works to include longitudinal follow-up data. These works will focus on identifying amenable factors that could be integrating into policy and programming to improve the mental health of adolescent parents (both mothers and fathers) affected by HIV, and the development of their children. These works will also on developing a greater understanding the experience of fathers of children born to adolescent mothers (an often-overlooked group)2. Develop analyses and manuscripts for publication and dissemination 3. Attend conferences, and stakeholder meetings to allow for knowledge transition and networking 4. Develop the foundations for future possible collaborations focusing on the mental health of adolescent parent families from both sub-Saharan Africa and high-income countries with the aim of extend the application of findings from both the thesis and postdoctoral activities5. Undertake further training to build skills relating to methodology, and to establish a career in academia 6. Develop funding applications to advance the works undertaken as part of this postdoctoral fellowship, and to further address the need for data to allow for the effective development of meaningful policy and programming to serve current and future generations