Rakai Adolescent Project (RAP)

拉凯青少年项目 (RAP)

• 批准号: 7667611
• 负责人: JOHN S. SANTELLI
• 金额: $ 43.08万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7667611
• 关键词: Abstinence; Achievement; Adolescence; Adolescent; Adolescent Development; Adult; Africa; Africa South of the Sahara; Age; Anti-Retroviral Agents; Behavior; Behavioral; Biological; Biological Factors; Caring; Case-Control Studies; Characteristics; Cohort Studies; Collection; Communities; Data; Data Collection; Data Set; Development; Developmental Process; Disinhibition; Education; Educational Intervention; Ethnography; Face; Fatigue; Foundations; Future; Gender Role; Generations; Goals; HIV; Health Sciences; Health behavior; Health education; Healthcare; Incidence; Individual; Infection; Infection prevention; International; Intervention; Life; Link; Male Circumcision; Marital Status; Marriage; Modeling; Never Married; Outcome; Outcome Study; Pathway interactions; Pattern; Peer Pressure; Perception; Phase; Play; Policies; Pregnancy; Prevalence; Prevention; Prevention approach; Prevention program; Prevention strategy; Qualitative Methods; Qualitative Research; Questionnaires; Recommendation; Reproductive Health; Research; Research Design; Research Infrastructure; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Role; Schools; Seroprevalences; Sex Behavior; Sexual Partners; Sexual Transmission; Sexually Transmitted Diseases; Shapes; Social Development; Social Environment; Staging; Surveys; Time; Uganda; Unplanned pregnancy; Validation; Virus Diseases; Work; Youth; aged; base; biopsychosocial; boys; child bearing; cohort; condoms; critical period; design; dissemination research; expectation; experience; girls; improved; innovation; insight; interest; longitudinal analysis; optimism; programs; psychosocial; pubertal timing; public health relevance; response; risk perception; sex risk; sexual debut; sexual relationship; social; success; transmission process; trend; young adult

DESCRIPTION (provided by applicant): Through political commitment and community mobilization, Uganda has made notable progress in containing HIV prevalence using a variety of prevention approaches including partner reduction, promotion of ABC (Abstinence, Be Faithful, Use Condoms), and openness regarding HIV. However, stable HIV incidence among young people (1-3% per year), increases in HIV risk behaviors, and new concerns about prevention fatigue and behavioral disinhibition have tempered optimism generated by Uganda's prevention successes. Using an innovative combination of quantitative and qualitative methods, as well as a comprehensive theoretical framework for HIV transmission, the Rakai Youth Project (RYP) would first explore the changing patterns of HIV incidence among youth 15-24 years and would assess the influence of social and developmental risk factors for new HIV infections over time. The existing Rakai Community Cohort Study (RCCS) offers a unique opportunity to explore risk factors for HIV infection among youth, providing a longitudinal dataset with a broad array of potential HIV determinants, over 18 years (1994-2012). These include social context, individual psychosocial and social developmental factors, sexual behaviors, and biological factors. We will compare the specifics of HIV risks by marital status and age of partners, by school attendance and achievement, and on the basis of pregnancy intentions and desires. Moreover, the umbrella Rakai Health Sciences Program has a well-developed Qualitative Research Department that allows for the exploration of the nuanced pathways between social and developmental factors and HIV infection---including the influence of HIV prevention programs, adolescent life goals and opportunities, peer pressure, relationship dynamics, and other social influences---that are difficult to fully capture in quantitative questionnaires. A second project aim would explore the specific role of HIV policies and programs in influencing HIV incidence among youth in the Rakai District. The RYP will explore changing HIV risk over four key "generations" of HIV prevention and care programs in Uganda: the "Zero grazing" era, the shift to ABC and abstinence education, the post anti-retroviral (ARV) treatment generation, and young people who have come of age after the advent of male circumcision (MC) availability. The new availability of ARVs and MC has raised considerable concerns about behavioral disinhibition among youth. Colleagues from Uganda and the U.S. will work together to synthesize and triangulate these findings. On the basis of the research findings, the RYP will develop recommendations for structural-level and educational interventions for youth in Rakai, Uganda, and elsewhere who are at-risk of HIV infection. Related research dissemination activities will be targeted strategically toward key policy and program leaders at the community, national, and international levels. PUBLIC HEALTH RELEVANCE: The proposed Rakai Youth Project (RYP) would explore the changing patterns of HIV incidence among youth 15-24 years and will assess the influence of social and developmental risk factors for new HIV infections over time. We would use new qualitative data collection and the existing Rakai Community Cohort Study to explore changing risk factors for HIV infection among youth over the period 1994-2012. The RYP would also explore the specific role of HIV policies and programs in influencing HIV incidence among youth in the Rakai District and develop recommendations for structural-level and educational interventions for youth HIV prevention.

描述（由申请人提供）：通过政治承诺和社区动员，乌干达在控制艾滋病毒流行方面取得了显著进展，采取了各种预防措施，包括减少伴侣，促进ABC（禁欲，忠诚，使用避孕套）和对艾滋病毒的开放。然而，年轻人的艾滋病毒发病率稳定（每年1-3%），艾滋病毒风险行为的增加，以及对预防疲劳和行为解除抑制的新担忧，削弱了乌干达预防成功所带来的乐观情绪。利用定量和定性方法的创新结合以及艾滋病毒传播的综合理论框架，Rakai青年项目将首先探索15-24岁青年中艾滋病毒发病率的变化模式，并将评估随着时间的推移社会和发展风险因素对新感染艾滋病毒的影响。现有的Rakai社区队列研究（RCCS）为探索青少年感染艾滋病毒的风险因素提供了一个独特的机会，提供了一个纵向数据集，其中包含了18年（1994-2012）期间广泛的潜在艾滋病毒决定因素。这些因素包括社会背景、个人心理社会和社会发展因素、性行为和生物因素。我们将根据伴侣的婚姻状况和年龄、上学情况和成绩以及怀孕意图和愿望来比较艾滋病毒风险的具体情况。此外，Rakai健康科学项目有一个完善的定性研究部门，可以探索社会和发展因素与艾滋病毒感染之间的微妙途径，包括艾滋病毒预防项目的影响、青少年生活目标和机会、同伴压力、关系动态和其他社会影响，这些很难在定量问卷中完全捕捉到。第二个项目的目标是探讨艾滋病毒政策和方案在影响拉凯地区青年艾滋病毒发病率方面的具体作用。该计划将探讨乌干达艾滋病毒预防和护理项目的四个关键“世代”中艾滋病毒风险的变化：“零放牧”时代、向ABC和禁欲教育的转变、抗逆转录病毒（ARV）治疗后的一代，以及在男性包皮环切术（MC）普及后成年的年轻人。arv和MC的新可用性引起了对青少年行为抑制解除的相当大的关注。来自乌干达和美国的同事将共同对这些发现进行综合和三角测量。在研究结果的基础上，该计划将为乌干达Rakai和其他地方有艾滋病毒感染风险的青年制定结构层面和教育干预措施的建议。相关的研究传播活动将战略性地针对社区、国家和国际层面的关键政策和项目领导者。