E Kinyanda, MRC/UVRI Uganda Research Unit on AIDS - Mental health among HIV infected CHildren and Adolescents in KAmpala, Uganda (CHAKA)

艾滋病毒对撒哈拉以南非洲儿童和青少年的影响尤为严重，90%的感染者居住在那里。乌干达是该地区感染率第五高的国家，在120万艾滋病毒感染者中，有10%以上的人年龄在15岁以下。除了身体上的影响，感染艾滋病毒的儿童和青少年（CA-HIV）报告心理健康状况不佳。来自高收入国家的流行病学研究发现，精神障碍（PD，如抑郁、焦虑和行为障碍）的发病率很高。CA-HIV患者PD危险因素的证据尚无定论。然而，潜在的风险因素包括：孕产妇健康状况不佳；艾滋病毒疾病严重程度；照顾者PD;与艾滋病毒有关的神经/发育残疾；耻辱、家庭死亡和负面环境因素；疼痛;还有遗传因素。尽管撒哈拉以南的非洲地区是青少年感染艾滋病毒最多的地区，但很少有研究能更好地了解该地区CA-HIV患者的精神问题。本研究的目的是调查PD对乌干达CA-HIV的影响及其对服务提供的影响。本研究的目的是：(1)确定CA-HIV患者PD（包括神经认知障碍）的患病率、12个月发病率和预测因素；(2)探讨血清素转运体基因差异与抑郁症的关系；(3)检查PD对HIV疾病进展的影响；(4)检查PD对社会和学业功能以及危险行为（即治疗依从性、酒精使用、性行为和自杀行为）的影响；(5)调查寻求帮助的行为并确定乌干达艾滋病毒服务中的服务提供差距。这些目标将通过对来自乌干达城市和农村两家儿科艾滋病毒诊所的1,260名CA-HIV及其护理人员进行队列研究来实现。社会人口特征和心理社会、临床、遗传和生物学数据将由训练有素的精神病学研究护士和临床医生在基线和6个月和12个月的随访中收集。在队列中，我们将对48名诊断为精神障碍（PD）的CA-HIV患者及其护理人员进行定性亚研究，以探讨PD求助行为、未满足的护理需求和对精神卫生保健服务的期望的解释模型。访谈将在基线评估后的两个月内和12个月随访期间进行两次。乌干达的艾滋病毒护理服务目前正处于从垂直护理结构过渡到完全纳入正式保健系统的过程中，该系统侧重于艾滋病毒/艾滋病感染者的需求。这项及时的研究结果将为决策者和服务提供者提供宝贵的信息，以加强为这一弱势群体提供适当和有效的精神卫生保健。

HIV disproportionately affects children and adolescents in sub-Saharan Africa, where 90% of those infected reside. In Uganda, the country with the fifth highest prevalence rate in the region, more than 10% of the 1.2 million people living with HIV are under the age of 15. In addition to its physical impact, HIV infected children and adolescents (CA-HIV) report poor mental wellbeing. Epidemiological research from high-income countries has found high rates of psychiatric disorder (PD; e.g. depression, anxiety and behaviour disorders). Evidence on risk factors for PD in CA-HIV remains inconclusive. However, potential risk factors include: poor maternal health; HIV disease severity; caregiver PD; HIV related neurological/developmental disability; stigma, death in the family and negative environmental factors; pain; and genetic factors. Although sub-Saharan Africa shoulders the greatest burden of youth HIV, little research has been conducted to better understand psychiatric problems among CA-HIV in the region. The aim of this study is to investigate the impact of PD on CA-HIV in Uganda and the implications for service provision. The objectives of this study are to: (1) determine the prevalence, 12-month incidence and predictors of PD (including neurocognitive impairment) among CA-HIV; (2) investigate the relationship between differences in the serotonin transporter gene and depressive disorder; (3) examine the impact of PD on HIV disease progression; (4) examine the impact of PD on social and academic functioning and risky behaviours (i.e. treatment adherence, alcohol use, sexual behaviour and suicidal behaviour); and (5) investigate help-seeking behaviour and identify service delivery gaps in Ugandan HIV services. These objectives will be met through a cohort study of 1,260 CA-HIV and their caregivers from two paediatric HIV clinics in urban and rural Uganda. Socio-demographic characteristics and psychosocial, clinical, genetic and biological data will be collected by trained psychiatric research nurses and study clinicians at baseline and six and 12 month follow-up. Nested in the cohort, we will carry out a qualitative sub-study of 48 CA-HIV diagnosed with a psychiatric disorder (PD) and their caregivers to investigate explanatory models of PD help-seeking behaviour, unmet needs of care and expectations from mental health care services. Interviews will be conducted on two occasions, within two months of baseline assessment and at 12 month follow-up.HIV care services in Uganda are currently in the process of transitioning from a vertical care structure to one fully integrated into the formal health care system which focuses on the needs of people living with HIV/AIDS. The results of this timely study will provide policymakers and service providers with invaluable information to strengthen the provision of appropriate and effective mental health care for this vulnerable group.