Adapting CHAMP+ for South Africa: Supporting HIV-Infected Youth and Families

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DESCRIPTION (provided by applicant): HIV is a major threat to the health and psychosocial well-being of children, particularly in low-resource countries that have had limited access to antiretroviral treatments (ART) and thus high rates of perinatal HIV transmission. South Africa (SA) has one of the highest HIV prevalence rates in the world. Recently, a national plan was initiated to make ART widely available in SA which will result in a growing population of children who survive and must live with HIV disease as a chronic, stigmatizing, and transmittable illness, with the potential for significant public health consequences. The Collaborative HIV Prevention and Adolescent Mental Health Projects or CHAMP was originally developed in the United States (US) for un-infected youths and was subsequently adapted for perinatally HIV-infected youths to prevent risk behavior and promote mental health (Champ+). The proposed study will adapt, refine, and pilot test this family based intervention for SA perinatally HIV-infected 9-13 year-olds (Champ+SA) and will examine 1) the process of cultural and contextual adaptation of CHAMP+SA and 2) the preliminary impact of Champ+ SA on short term proximal outcomes for a) youth (e.g., coping, HIV knowledge, self esteem) and b) family/social process (e.g., communication, support, supervision) variables that promote c) youth behavioral health outcomes (e.g., mental health, ART adherence, and reduction of sexual and drug risk behavior). We will use a community-based participatory research (CBPR) approach in Phase 1(Year 1) to adapt the intervention to the SA context of medical and psychosocial treatment for HIV+ youth. The investigative team will adapt the curriculum and study procedures via a series of consultations with consumers (HIV+ youth and their caregivers), and health care providers, working closely with nursing staff, HIV counselors, and psychology trainees who are primarily responsible for psychosocial programs at McCord Hospital in Durban, where this study will take place. In Phase 2 (Year 2), we will conduct a small randomized trial of CHAMP+SA with 30 families in care at the Hospital. They will be randomized to either the intervention or a delayed intervention condition. Guided by a modified Social Action Theory model, participants will be assessed --pre- and post-test on behavioral health outcomes, youth self- regulation, family process and contextual variables. Process variables related to the adaptation and implementation of CHAMP+SA, including barriers and facilitators of feasibility and acceptability will also be collected. The findings can be used to inform larger-scale effectiveness studies in similar settings.