HIV Prevention for Batswana Youth: Adaptation of an Evidence-Based Intervention

描述（申请人提供）：博茨瓦纳是世界上艾滋病毒感染率第二高的国家，30-34岁人群的感染率最高，达到40.2%。博茨瓦纳还在提供普遍免费获得AZT、预防母婴传播、广泛的VCT中心网络和全国范围内的男性包皮环切规划方面处于世界领先地位。然而，这种强调病例发现、护理和治疗的生物医学策略并没有与初级预防项目并行。将于2010年发布的新的国家战略计划现在将引进和适应基于证据的行为预防作为近期的最高战略优先事项。正是为了响应新的战略计划，这个合作的R34提案被提交，以适应和试点一个以证据为基础的计划，成为一个负责任的青少年（BART）干预，为巴茨瓦纳青年。在青少年咨询委员会和社区咨询委员会的指导下，我们将在第一年与青少年进行焦点小组讨论，并与关键线人进行深入访谈，以了解Gabarone中学14-19岁青少年的测量方案和干预措施的适应情况。在第二年，将对这些措施进行试点测试，以确定其心理测量特性，并按性别比较反应。将起草角色扮演小短文，评估其社会和生态有效性，并将BART干预措施调整为博茨瓦纳青少年。将增加新的文化上适当的模块，处理酒精作为风险因素、解决冲突以减少亲密伴侣暴力和减少污名。此外，还将增加一项针对父母的新的3期干预计划和一项针对家庭看护人的单独3期计划，涉及艾滋病毒/艾滋病信息，与青少年就敏感话题进行沟通，并进行监测。在第三年，一项试点可行性研究将评估招募、保留、干预人员的忠诚，以及青少年和父母/看护人对各自干预措施的反应。以及研究结果是否表明，与中学现有的生活技能课程相比，博茨瓦纳版本的BART提供了附加值。这一开发应用程序是博茨瓦纳大学、哈博罗内政府机构和非政府组织以及密西西比州立大学合作开发的程序序列的第一步。如果可行性试验记录了行为的积极变化，它将通知R01申请一个更大的随机对照试验，包括认知，行为和生物学终点。如果随机对照试验提供了有效的有力证据，我们将与教育部、卫生部、青年和文化部合作，在博茨瓦纳的中学推广这一干预措施，并培训每个社区的工作人员，忠实地实施该方案。

DESCRIPTION (provided by applicant): Botswana has the 2nd highest HIV prevalence in the world, peaking at 40.2% in 30-34 year olds. Botswana also has been the world's leader in providing universal free access to AZT, prevention of mother to child transmission, an extensive network of VCT centers, and a nationwide male circumcision program. However, this emphasis on biomedical strategies for case finding, care, and treatment has not been paralleled by primary prevention programs. The new national strategic plan to be issued in 2010 now places importation and adaptation of evidence-based behavioral prevention as the highest strategic priority for the immediate future. It is in response to the new strategic plan that this collaborative R34 proposal to adapt and pilot an evidence-based program, the Becoming a Responsible Teen (BART) intervention, for Batswana youth is submitted. Guided by a teen advisory committee and a community advisory board, we will conduct focus groups with youth and in-depth interviews with key informants in the first year to inform adaptation of the measurement protocol and intervention for youths 14-19 in Gabarone secondary schools. In the 2nd year, measures will be pilot tested to establish their psychometric properties and to compare responses by gender. Role play vignettes will be drafted, their social and ecological validity assessed, and the BART intervention will be adapted for Batswana adolescents. New culturally appropriate modules addressing alcohol as a risk factor, conflict resolution to reduce intimate partner violence, and stigma reduction will be added. In addition, a new 3-session intervention for parents and a separate 3-session program for household caretakers will be added, addressing HIV/AIDS information, communicating with youth on sensitive topics, and monitoring, In the 3rd year, a pilot feasibility study will assess recruitment, retention, interventionists' fidelity, and youth and parents/caretakers' response to their respective interventions, and whether the results suggest that the Botswana version of BART provides value added when compared against the existing Life Skills curriculum in the secondary schools. This developmental application is the first step in a programmatic sequence developed in collaboration between the University of Botswana, governmental agencies and NGOs in Gaborone, and Mississippi State University. If the feasibility trial documents positive changes in behavior, it will inform a R01 application for a larger randomized controlled trial with cognitive, behavioral and biological endpoints. If the RCT provides strong evidence of effectiveness, we will work with the Ministries of Education, Health, and Youth and Culture to disseminate the intervention throughout Botswana's secondary schools and train staff in each community to deliver the program with fidelity.