Family Prevention of HIV Risk and Depression in HIV-endemic South Africa

描述（由申请人提供）：在艾滋病毒流行的南非，家庭中的艾滋病毒风险和抑郁症对全球艾滋病毒流行最严重的国家构成了重大的公共卫生挑战。在这些家庭中，青少年感染艾滋病毒和抑郁的风险更高。此外，他们的成年照顾者（亲生父母或代孕父母）患抑郁症的风险也在上升。越来越多的证据表明，艾滋病毒风险行为和抑郁症的家庭风险和保护因素，强调需要采取家庭预防措施。然而，艾滋病毒流行社区的家庭预防科学存在重大差距。现有的家庭预防措施很少以一种综合模式针对艾滋病毒风险和抑郁；强调基于弹性的方法；适应于南非本K01的科学目标是将两种经验支持的艾滋病毒风险模型（Keepin’It Real）和抑郁症模型（Family Talk）整合到适合南非的统一家庭预防干预中，并测试初步的可接受性和可行性。这一K01的培训目标是获得密集的有指导的培训，使PI做好准备，成为艾滋病毒流行社区儿童和照料者性健康和心理健康复原力家庭预防干预方面的主要研究人员。培训发展家庭预防干预办法方面的专门知识；培养技能，使预防干预措施适应南非的情况，并将其标准化为一本手册；发展预防干预设计和实施方面的专业知识，重点是RCT研究设计；并在评估方案依从性、治疗保真度和可接受性、机制测量和试验有效性方面建立统计和分析技能。培训与三个学习目标有关。目标1是将针对艾滋病毒风险和抑郁症的两项现有预防性干预措施纳入一个统一的模式，并调整内容和语言，使其适合南非。目标1将通过与照料者（18岁以上）和青少年（13-15岁）的焦点小组以及与精神和艾滋病毒预防专家、社区领袖和从业人员的访谈来实现。目标2将预防性干预标准化为手册，并培训辅导员。目标3评估招募和保留干预措施的可行性和可接受性。目标3将随机分配124名照顾者-青少年（预防干预组n=62，对照组n=62），并在基线、干预后立即和干预后三个月进行评估。研究结果为在全功率RCT中进行预防性干预试验的未来计划提供了信息。该研究推进了NIMH的优先事项：1)提高艾滋病毒感染家庭的心理健康服务的有效性；2)制定干预措施，预防艾滋病毒感染，并提高青少年对健康保护行为的依从性；3)开发适合年龄、语言和文化的项目；4)促进受艾滋病毒影响的少数群体社区心理健康的多学科研究和培训。该研究填补了在高危人群和环境中家庭预防科学的重大空白。

DESCRIPTION (provided by applicant): HIV risk and depression among families in HIV-endemic South Africa present significant public health challenges to a country with the largest HIV epidemic globally. In these families, adolescents face elevated risk for HIV and depression. Furthermore, their adult caregivers (biological or surrogate parents) are also at escalated risk fo depression. Growing evidence indicates family risk and protective factors for HIV risk behaviors and depression, underscoring the need for a family prevention approach. However, key gaps exist in family prevention science in HIV-endemic communities. Few existing family preventions target HIV risk and depression in one integrated model; emphasize a resilience based approach; and are adapted to South Africa. The scientific objective of this K01 is to integrate two empirically supported models for HIV risk (Keepin' It Real) and depression (Family Talk) into a unified family preventive intervention appropriate for South Africa and test initial acceptabilit and feasibility. The training objective of this K01 is to obtain intensive mentored training that wll prepare the PI to become a leading researcher on family preventive interventions for sexual and mental health resilience among children and caregivers in HIV-endemic communities. Training develops expertise in family preventive intervention approaches; builds skills to adapt preventive interventions to South Africa and standardize into a manual; develops expertise in preventive intervention design and implementation with a focus on RCT study designs; and builds statistical and analytical skills in assessment of protocol adherence, treatment fidelity and acceptability, mechanism measurement, and trial efficacy. Training is linked to three study aims. Aim 1 is to integrate two existing preventive interventions for HIV risk and depression into a unified model and adapt the content and language to be appropriate for South Africa. Aim 1 will be accomplished through focus groups with caregivers (18+ years) and adolescents (13-15 years) and interviews with mental and HIV prevention experts, community leaders, and practitioners. Aim 2 standardizes the preventive intervention into a manual and trains facilitators Aim 3 assesses feasibility regarding recruitment and retention and acceptability of the intervention. Aim 3 will be accomplished with randomization of 124 caregiver- adolescent dyads (n=62 dyads in the preventive intervention group, n=62 dyads in the control group) and assessments at baseline, immediately post-intervention, and three months post-intervention. Findings inform future plans for preventive intervention testing in a fully-powered RCT. The study advances NIMH priorities by 1) improving effectiveness of mental health services for HIV-affected families; 2) developing interventions to prevent HIV-infection and to improve adherence to health protective behaviors in adolescents; 3) developing age, language, and culture-appropriate programs; and 4) promoting multidisciplinary research and training on mental health of HIV-affected minority communities. The study fills a significant gap in family prevention science in a high risk population and setting.