HIV and Substance Use Prevention for South African Youth and Families

描述（由申请人提供）：南非（SA）是世界上艾滋病毒携带者/艾滋病（PLWHA）人数最多的国家。南非的青年艾滋病毒新感染人数增长最快，在西开普省，精神健康问题和药物使用日益加剧了新感染人数。家庭可以成为预防艾滋病毒工作的有效合作者，但对南非青少年，特别是有精神健康问题和吸毒/酗酒的青少年，没有以家庭为基础的干预措施。这项发展研究将适应和试点测试一个多层次的，非常有前途的，艾滋病毒和酒精/药物使用预防计划（项目风格）为南非的照顾者和他们的青少年接受门诊心理健康服务。STYLE项目是在美国三个城市的750名患有精神疾病的青少年中设计和测试的，我们将结合adapt - itt和CDC的指导方针，系统地使其适应南非的环境。第一阶段将包括广泛的形成性工作（例如，焦点小组、反馈小组、深度访谈、戏剧测试），对调查工具和课程的修订，以及翻译/反翻译成南非荷兰语和南非语。我们将组建一个咨询委员会，就调整和修订提出建议。在第二阶段，我们将对两组接受心理健康服务的14 - 18岁的父母-青少年进行试点测试。青少年将来自所有种族（即白人，黑人和有色人种）的男性和女性。我们将根据参与者的综合评价、观察和推动者评分来修改研究程序和材料。在第三阶段，我们将重新测试修改后的程序，随机分配到60对父母-青少年二人组，与对照组进行对比。所有参与者将完成基线和3个月的随访访谈，以评估跟踪、保留和初步治疗效果。在艾滋病毒风险的社会-个人框架和性别与权力理论的指导下，干预措施将针对个人属性、同伴和伴侣关系过程以及家庭背景，以减少南非青年中的危险性行为和吸毒/酗酒。鉴于该研究的探索性性质，我们将谨慎地检查理论中介、危险性行为和药物滥用的变化作为项目参与的函数，我们将确定项目对组间hiv风险行为影响的前测后效应大小。这项研究的长期目标是为南非青少年和父母制定一个非常有前途的、基于科学的艾滋病毒和药物使用预防计划，该计划可以在大规模的有效性研究中进行测试。本研究与R34指南一致，支持干预开发的早期阶段和初步测试，以检查可行性、可接受性和耐受性。

DESCRIPTION (provided by applicant): South Africa (SA) has the largest number of people living with HIV/AIDS (PLWHA) in the world. Youth in SA are experiencing the fastest increase in new HIV infections, and in the Western Cape region, new infections are increasingly fueled by mental health problems and substance use. Families can be effective collaborators in HIV prevention efforts, but no family-based interventions exist for South African teens, particularly those with mental health problems and drug/alcohol use. This developmental study will adapt and pilot test a multi-level, highly promising, HIV and alcohol/drug use prevention program (Project STYLE) for South African caregivers and their teens receiving outpatient mental health services. Project STYLE was designed and tested with 750 mentally ill teens across three US cities, and we will systematically adapt it for the South African context using a combination of ADAPT-ITT and CDC guidelines. Stage 1 will involve extensive formative work (e.g., focus groups, feedback groups, in-depth interviews, theater testing), revisions to survey instruments and the curriculum, and translation/back-translation into Afrikaans and isiXhosa. We will assemble a CAB to advise in the adaptations and revisions. In Stage 2, we will pilot test the revised intervention with two groups of 14 - 18 year old parent-teen dyads receiving mental health services. Teens will be male and female from all ethnic groups (i.e., White, Black, and Colored). We will revise study procedures and materials based on comprehensive participant evaluations, observations, and facilitator ratings. In Stage 3, we will re-test the revised program with 60 parent-teen dyads randomly assigned to Project STYLE versus a control group. All participants will complete baseline and 3-month follow-up interviews to evaluate tracking, retention, and preliminary treatment effects. Guided by a Social-Personal framework6 of HIV-risk and the Theory of Gender and Power, the intervention will target personal attributes, peer and partner relationship processes, and family context to reduce risky sexual behavior and drug/alcohol use among South African youth. Given the exploratory nature of the study, we will cautiously examine change in theoretical mediators and risky sexual behavior and substance abuse as a function of program participation, and we will determine the pretest-posttest effect size of program impact on HIV-risk behavior between groups. The long-term goal of the study is to adapt a highly promising and scientifically-based HIV and substance use prevention program for South African teens and parents that can be tested in a large-scale effectiveness study. This study is consistent with R34 guidelines to support the early phase of intervention development and preliminary testing to examine feasibility, acceptability, and tolerability. PUBLIC HEALTH RELEVANCE: Sub-Saharan Africa is the global epicenter of the AIDS epidemic, and South Africa is estimated to have the largest number of people living with HIV/AIDS in the world. With youth experiencing the fastest increase in new HIV infections in South Africa, stemming transmissions is a global public health priority. Unfortunately, national efforts have been disappointing; 50% of South African youth are sexually experienced, 25% were previously diagnosed with an STI, and 40% report sexual activity involving blood. Similarly, adolescent rates of alcohol and other drug use are rising, and age at first use (13 - 16 years old) for the majority (54%) is young. Likewise, despite high-risk taking among teens in psychiatric care, and the World Health Organization's statement that "there can be no health without mental health," mental health has been a low priority in South Africa. Disproportionate rates of HIV infection among South Africans may reflect, in part, few available mental health services, while improved mental health care may reduce the spread of HIV/AIDS. In the Western Cape region of South Africa, associations among sexual risk taking, alcohol and drug use, and mental illness are fueling HIV/AIDS infections among youth. Families can be effective collaborators in HIV prevention efforts, but no family-based interventions exist for South African teens, particularly those with mental health problems and drug/alcohol use. This developmental study will adapt and pilot test a multi-level, highly promising, HIV and alcohol/drug use prevention program (Project STYLE) for this exceptionally high-risk population. Simultaneously addressing sexual risk taking, mental health, and substance use among South African youth has the potential to reduce these intersecting epidemics. The long-term goal of the proposed project is to develop an empirically-validated, theoretically-based family-focused HIV and substance use prevention program to reduce health risk behavior among South African youth with mental health problems.