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

描述（由申请人提供）：艾滋病毒是对儿童健康和心理社会福祉的主要威胁，特别是在资源匮乏的国家，这些国家获得抗逆转录病毒治疗的机会有限，因此围产期艾滋病毒传播率很高。南非是世界上艾滋病流行率最高的国家之一。最近，南非启动了一项国家计划，在南南非广泛提供抗逆转录病毒治疗，这将导致越来越多的儿童存活下来，但他们必须感染艾滋病毒，这是一种慢性、耻辱性和传染性疾病，可能造成严重的公共卫生后果。艾滋病毒预防和青少年心理健康合作项目（CHAMP）最初是在美国为未感染艾滋病毒的青少年制定的，后来适用于围产期感染艾滋病毒的青少年，以预防危险行为和促进心理健康（CHAMP +）。本研究将对9-13岁围生期HIV感染的SA （Champ+SA）进行调整、完善和试点测试，并将检验1)Champ+SA的文化和情境适应过程，以及2)Champ+SA对短期近端结果的初步影响：a)青少年（如应对、HIV知识、自尊）和b)家庭/社会过程（如沟通、支持、监督）变量促进c)青少年行为健康结果(如：精神健康、抗逆转录病毒治疗依从性以及减少性和药物风险行为)。我们将在第一阶段（第一年）采用基于社区的参与性研究（CBPR）方法，使干预措施适应艾滋病毒阳性青年医疗和心理社会治疗的SA背景。调查小组将通过与消费者（艾滋病毒阳性青年及其照顾者）和卫生保健提供者进行一系列磋商来调整课程和研究程序，并与德班麦考德医院主要负责社会心理项目的护理人员、艾滋病毒咨询师和心理学受训人员密切合作。该研究将在德班麦考德医院进行。在第二阶段（第2年），我们将在医院护理的30个家庭中进行CHAMP+SA的小型随机试验。他们将被随机分为干预组和延迟干预组。在改进的社会行为理论模型的指导下，对参与者进行行为健康结果、青少年自我调节、家庭过程和环境变量的前测和后测。还将收集与CHAMP+SA适应和实施相关的过程变量，包括可行性和可接受性的障碍和促进因素。研究结果可用于在类似环境下进行更大规模的有效性研究。

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.