Brazilian HIV/STI Prevention for Adolescents with Mental Health Disorder

描述（由申请人提供）：患有精神健康障碍（MHD）的青少年比一般人群有更高的艾滋病毒/性传播感染风险行为率。在巴西，艾滋病毒检测呈阳性的青年比艾滋病毒阴性的青年有更多的MH问题；在针对青少年的卫生保健中，没有定期实施减少艾滋病毒/性传播感染风险的措施。巴西卫生部资助了我们小组的成员进行区域需求评估，以实施基于证据的艾滋病毒预防干预措施，作为未来在提供MH护理的环境中在全国范围内推广的试点（APQ-01246-10； PI：吉马拉斯）。我们在巴西里约热内卢的nimh资助的RCT（里约热内卢；R01MH065163; PI: Wainberg）承诺为患有MHD的成年人提供这种干预措施。巴西没有类似的以证据为基础的青少年艾滋病毒/性传播感染预防干预措施；这个应用程序针对这种需求。我们建议a)在巴西为MHD青少年提供大部分护理的三种类型的环境中，采用美国有效的以家庭为基础的HIV预防干预措施（STYLE; R01MH63008; PI: Brown）；b)对干预措施进行试点测试，以检查在这些环境中产生的巴西干预措施（STYLE-B）的可接受性、可行性和实施参数，并确定为功效随机对照试验做准备的关键研究参数。采用定量和定性的方法，我们将探讨背景对13-18岁巴西MHD青少年性风险行为的影响，为干预适应提供信息；我们将利用itaboai Youth （PI: Bordin）的样本，这是一项针对itaboai青少年MH资源的研究，itaboai是b里约热内卢大都市区的一部分，我们已经确定了风险。然后，我们将在四个以社区为基础的地点对患有MHD的13-18岁男女青年样本（n=144）进行STYLE-B试点测试。青少年/照顾者组将接受全天的小组会议，两周后返回青少年/照顾者组会议，三个月后参加半天的小组会议。可接受性和可行性将在每次会议后使用流程措施进行评估。我们将评估从基线到干预后3个月的性危险行为结果的变化。我们将阐明影响干预措施采用的因素（例如，招聘、转介、资源、气候、准备和干预能力）在巴西的三个服务系统中患有MHD的青年。我们将开发数字互动技术来培训干预助理员。巴西的妇幼保健/卫生服务系统在全国范围内传播抗逆转录病毒药物，并注重改善妇幼保健护理和艾滋病毒/性传播感染青少年的预防，以及政府让我们的团队成员参与这些举措，表明b型方案有可能在全国实施。我们的建议为在现实世界的MH社区服务系统中进行STYLE-B效能测试奠定了基础，这是巴西、美国和世界各地资源丰富和资源匮乏地区最常见的MH服务提供环境。

DESCRIPTION (provided by applicant): Adolescents with mental health (MH) disorders (MHD) have higher rates of HIV/STI sexual risk behaviors than those in the general population. In Brazil, youth testing positive for HIV had more MH problems than HIV- negative youth; HIV/STI sexual risk reduction is not regularly implemented within MH care for adolescents. The Brazil Ministry of Health has funded members of our team to conduct a regional needs-assessment to implement evidence-based HIV prevention interventions as a pilot for future country-wide dissemination in settings providing MH care (APQ-01246-10; PI: Guimaraes). Our NIMH-funded RCT in Rio de Janeiro (Rio; R01MH065163; PI: Wainberg) promises to provide such intervention for adults with MHD. A comparable evidence-based HIV/STI prevention intervention for adolescents is not available in Brazil; this application targets this need. We propose to a) adapt a U.S. efficacious family-based HIV prevention intervention for youth with MHD (STYLE; R01MH63008; PI: Brown) within the three types of settings providing most of the care to adolescents with MHD in Brazil; and b) pilot test the intervention to examine the acceptability, feasibility, and implementation parameters of the resulting Brazil intervention (STYLE-B) within these settings, and to determine key research parameters in preparation for an efficacy RCT. Using quantitative and qualitative methods we will explore the contextual influences on sexual risk behavior of Brazilian youth ages 13-18 with MHD to inform intervention adaptation; we will leverage the sample of Itaborai Youth (PI: Bordin), a study addressing MH resources for adolescents in Itaborai, a city that is part of the Rio metropolitan area, where we have identified risk. We will then pilot-test STYLE-B with a sample of male and female youth age 13-18 years (n=144) with MHD who are in MH treatment in four community-based sites. Youth/caregiver dyads will receive a full-day group session, return in two weeks for an adolescent/caregiver dyad session, and participate in a half-day group session three months later. Acceptability and feasibility will be assessed using process measures after each session. We will assess change in sexual risk behavior outcomes from baseline to 3- months post-intervention. We will elucidate factors influencing intervention adoption (e.g., recruitment, referrals; resources; climate, readiness and capacity for intervention) within the three service systems for youth with MHD in Brazil. We will develop digital interactive technology to train intervention facilitators. The Brazilian MH/health delivery system with country-wide dissemination of antiretrovirals and focus on improving MH care and HIV/STI prevention among youth with MHD, and the government's involving members of our team in these initiatives indicate that STYLE-B has likelihood of being implemented nationally. Our proposal sets the stage for STYLE-B efficacy testing within real-world MH community service systems, which are the most common settings of MH service delivery both in high- and low-resource areas in Brazil, the US and worldwide.