Ecology of HIV /AIDS and Child Mental Health in Tanzania

说明(由申请人提供)：本申请是一项长期努力的一部分，目的是通过研究撒哈拉以南非洲艾滋病毒/艾滋病大流行对儿童健康的影响来扩大知识，并评估应对这些持续后果的战略。照料者患病和死亡对儿童心理健康的影响一直是一个相对被忽视的研究领域，特别是在发展中国家，面对越来越多的人认识到，受艾滋病毒影响的儿童本身在青春期或成年时感染艾滋病毒的风险最大。这项申请建立在芝加哥社区人类发展项目(PHDCN)的多层次和纵向设计、社区组织(KIWAKKUKI)的服务和倡导以及坦桑尼亚北部一家备受尊敬的医疗机构(KCMC)的研究能力的基础上。这项研究有三个主要目标。该项目首先进行邻里调查，以确定人口和结构特征、艾滋病毒污名/歧视、集体效能和具有代表性的莫市市区成年人和青年居民的艾滋病毒危险行为。这些社区中的一部分将被招募到一项试验性干预中，旨在通过在家庭和社区层面进行干预来改善儿童的心理健康。随后将对干预和控制社区进行重新评估，以衡量社会进程的变化。在家庭一级，该干预措施采用家庭护理模式：1)促进学龄前和青春期儿童主要照顾者的社会支持；2)提高他们的育儿技能；3)改善其子女的身体成长和心理健康。在社区一级，干预采用促进儿童健康的模式，以1)改善与儿童集体社会化有关的社会进程，2)促进儿童的身心健康，3)减少对艾滋病毒/艾滋病患者的污名和歧视。除了评估社区进程的变化外，还将衡量主要照顾者和儿童的心理健康结果。通过对一个城市地区进行这种全面和深入的研究，所获得的关于原则和程序的信息应提供机会，将这些干预措施和这种评估方法推广到受艾滋病毒大流行影响的东部和南部非洲其他地区。

DESCRIPTION (provided by applicant): This application is part of a long-term effort to expand knowledge through research on the health consequences for children of the HIV/AIDS pandemic in Sub-Saharan Africa and to evaluate strategies to cope with these persisting consequences. The mental health impact on children of caregivers becoming ill and dying has been a relatively neglected area of research particularly in the developing world and stands in the face of the growing awareness that HIV affected children are themselves among the most at risk for acquiring HIV in their adolescent or adult years. This application builds on the multilevel and longitudinal design of the Project on Human Development in Chicago Neighborhoods (PHDCN), the service and advocacy of a community-based organization (KIWAKKUKI) and the research capacity of a highly respected medical institution in Northern Tanzania (KCMC). There are three primary goals of this research. The project begins with a neighborhood survey to determine demographic and structural characteristics, HIV stigma/discrimination, collective efficacy, and youth HIV risk behaviors in a representative sample of adult and youth residents of Moshi Urban District. A subset of these neighborhoods will be recruited into an experimental intervention designed to improve child mental health by intervening at both the household and neighborhood levels. This will be followed by a reassessment of the intervention and control neighborhoods to measure change in social processes. At the household level the intervention uses a nurse home visitation model to 1) promote the social support of primary caregivers of preschool and preadolescent children, 2) to improve their child rearing skills and 3) to improve the physical growth and mental health of their children. At the neighborhood level, the intervention adopts a child health promotion model to 1) improve social processes related to the collective socialization of children, 2) promote the physical and mental health of children, and 3) reduce stigma and discrimination towards persons with HIV/AIDS. In addition to assessing change in neighborhood processes, mental health outcomes for the primary caregivers and children will be measured. Through such comprehensive and intensive study of one urban district, the information acquired on principles and procedures should provide the opportunity to extend these interventions and this evaluation approach to other regions of Eastern and Southern Africa impacted by the HIV pandemic.