Brazilian HIV/STI Prevention for Adolescents with Mental Health Disorder

描述(由申请人提供)：患有精神健康(MH)障碍(MHD)的青少年比一般人群有更高的HIV/STI性危险行为发生率。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；在对青少年的MH护理中，没有定期实施艾滋病毒/性传播感染性风险的减少。巴西卫生部资助了我们小组的成员进行区域需求评估，以实施循证艾滋病毒预防干预措施，作为未来在提供卫生保健的环境中在全国范围内传播的试点(APQ-01246-10；PI：Guimaraes)。我们在里约热内卢(RIO；R01MH065163；PI：Wainberg)由NIMH资助的RCT承诺为患有MHD的成年人提供此类干预。巴西没有针对青少年的类似的基于证据的艾滋病毒/性传播感染预防干预措施；这项申请针对的是这一需要。我们建议a)在巴西为患有MHD的青少年提供大部分护理的三种类型的环境中，采用美国有效的基于家庭的艾滋病毒预防干预措施(Style；R01MH63008；PI：Brown)；以及b)试点测试干预措施，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，并确定关键研究参数，为有效的RCT做准备。我们将使用定量和定性的方法，探索环境对患有MHD的巴西13-18岁青年的性危险行为的影响，以告知干预适应；我们将利用Itborai青年(PI：Bordin)样本，这是一项针对Itborai青少年MH资源的研究，Itborai是里约大都市区的一部分，我们已经确定了风险。然后，我们将在四个社区站点对13-18岁(n=144)患有MHD并正在接受MH治疗的男性和女性青年样本进行B型试验。青少年/照顾者二人组将接受全天的小组会议，两周后返回参加青少年/照顾者二人组会议，并在三个月后参加半天的小组会议。将在每届会议之后使用程序措施评估可接受性和可行性。我们将评估性危险行为结果从基线到干预后3个月的变化。我们将阐明在巴西为患有MHD的青少年提供的三个服务系统中影响干预采用的因素(例如，招聘、转介、资源、气候、准备和干预能力)。我们将发展数字互动技术，培训干预促进者。巴西的卫生保健/保健提供系统在全国范围内传播抗逆转录病毒药物，重点是改善患有MHD的青年的卫生保健和艾滋病毒/性传播感染预防，以及政府让我们的团队成员参与这些倡议，这表明Style-B有可能在全国范围内实施。我们的建议为在真实世界的卫生保健社区服务系统内进行B类疗效测试奠定了基础，卫生保健社区服务系统是卫生保健服务在巴西、美国和世界各地高资源和低资源地区提供的最常见的环境。

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.