Brazilian HIV/STI Prevention for Adolescents with Mental Health Disorder

巴西对患有精神健康障碍的青少年进行艾滋病毒/性传播感染预防

• 批准号: 8261297
• 负责人: Cristiane S. Duarte
• 金额: $ 20.14万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-03 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8261297
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent; Adoption; Adult; Age; Alcohol or Other Drugs use; Anal Sex; Anti-Retroviral Agents; Area; Attention; Behavior monitoring; Brazil; Caregivers; Caring; Child; Cities; Climate; Clinic; Clinical Services; Communication; Communities; Community Mental Health Services; Community Services; Country; Data; Diagnosis; Disease; Educational Intervention; Family; Family Process; Female; Focus Groups; Funding; Future; General Population; Goals; Government; HIV; HIV Seropositivity; HIV/STD; Health; Health Resources; Health Services Research; Health system; Healthcare; Human immunodeficiency virus test; Incidence; Individual; Intervention; Interview; Learning; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; National Institute of Mental Health; Needs Assessment; Outcome; Outpatients; Pharmaceutical Preparations; Policy Maker; Population; Preparation; Prevention; Prevention Research; Prevention program; Preventive Intervention; Process Measure; Provider; Public Health; Qualitative Methods; Randomized; Readiness; Research; Research Project Grants; Resources; Risk; Risk Reduction; Risk-Taking; Role; Sampling; Self Efficacy; Services; Sexuality; Site; Staging; Supervision; System; Technology; Teenagers; Testing; Training; Vagina; Youth; aged; base; cohesion; community based participatory research; condoms; digital; efficacy testing; efficacy trial; ethnographic method; evidence base; experience; health care delivery; high risk; improved; innovation; male; meetings; member; metropolitan; post intervention; programs; response; safer sex; sex; sex risk; skills; social; tool; working group

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. PUBLIC HEALTH RELEVANCE: Adolescents with mental health disorders are at substantial risk for acquiring HIV/STIs compared to their counterparts without mental disorders, yet few HIV/STI sexual risk reduction interventions have been developed to meet their unique needs. There is clear public health need for innovative methods of service delivery and effective strategies of HIV/STI sexual risk reduction that addresses multiple contexts of risk (i.e. family) for this high-risk population. Brazil, previously successful in the country-wide dissemination of antiretrovirals, is now focused on improving youth mental health care and HIV/STI prevention among individuals with mental health disorders, calling for efficacious HIV/STI sexual risk reduction interventions to be implemented nationally. The current proposal addresses this need by adapting a U.S. efficacious, provider- delivered, HIV/STI sexual risk reduction intervention to be implemented in outpatient mental health public settings in Brazil that will: 1) build the clinic' capacity to help families under their care to more comfortably address the adolescent's sexuality; 2) promote youth's safer sex practices; and 3) reduce HIV/STI sexual risk behaviors among adolescents with mental health problems. Lessons learned from the proposed project are likely to inform an efficacy trial and the implementation of interventions within Brazil and elsewhere.

描述（由申请人提供）：患有精神健康（MH）障碍（MHD）的青少年的艾滋病毒/性传播疾病性风险行为发生率高于普通人群。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生殖健康问题;在对青少年的生殖健康护理中，没有定期实施减少艾滋病毒/性传播感染性风险的措施。巴西卫生部资助我们的团队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MH护理的环境中在全国范围内传播的试点（APQ-01246-10; PI：吉马良斯）。我们在里约热内卢的NIMH资助的RCT（Rio; R 01 MH 065163; PI：Wainberg）承诺为MHD成人提供此类干预。巴西没有类似的针对青少年的循证艾滋病毒/性传播感染预防干预措施;这一应用针对这一需求。我们建议：a）针对MHD青少年采用美国有效的以家庭为基础的HIV预防干预措施（STYLE; R 01 MH 63008; PI：Brown）在三种类型的环境中为巴西的MHD青少年提供大部分护理;和B）对干预措施进行试点测试，以检查在这些环境中得到的巴西干预措施（STYLE-B）的可接受性、可行性和实施参数，并确定准备疗效RCT的关键研究参数。使用定量和定性的方法，我们将探讨的背景影响巴西青少年的性风险行为的13-18岁与MHD通知干预适应;我们将利用样本的伊塔博赖青年（PI：Bordin），一项研究，解决MH资源的青少年在伊塔博赖，一个城市，是里约大都市区的一部分，在那里我们已经确定的风险。然后，我们将在四个社区中心对13-18岁（n=144）接受MH治疗的MHD男性和女性青年样本进行STYLE-B的初步试验。青少年/照顾者二人组将接受一整天的小组会议，两周后返回青少年/照顾者二人组会议，并在三个月后参加半天的小组会议。可接受性和可行性将在每次会议后使用过程措施进行评估。我们将评估从基线到干预后3个月性风险行为结果的变化。我们将阐明影响干预措施采用的因素（例如，在巴西的MHD青少年三个服务系统中，对招募、转诊、资源、气候、准备和干预能力进行了评估。我们将开发数字互动技术，以培训干预促进者。巴西的生殖健康/保健提供系统在全国范围内传播抗逆转录病毒药物，重点是改善生殖健康护理和患有生殖健康缺陷的青年人中的艾滋病毒/性传播感染预防，政府让我们的团队成员参与这些举措，这表明STYLE-B有可能在全国范围内实施。我们的提案为在真实世界的MH社区服务系统中进行STYLE-B功效测试奠定了基础，这些系统是巴西，美国和全球高资源和低资源地区最常见的MH服务提供环境。 公共卫生相关性：与没有精神疾病的青少年相比，患有精神疾病的青少年感染艾滋病毒/性传播感染的风险很大，但为满足他们的特殊需要而制定的减少艾滋病毒/性传播感染风险的干预措施很少。显然，公共卫生需要创新的服务提供方法和有效的减少艾滋病毒/性传播感染风险的战略，以解决这一高危人群的多种风险环境（即家庭）。巴西以前在全国范围内成功地传播了抗逆转录病毒药物，现在则侧重于改善青年心理保健和在患有心理健康障碍的个人中预防艾滋病毒/性传播感染，呼吁在全国实施有效的减少艾滋病毒/性传播感染性风险的干预措施。目前的提案通过调整美国有效的、由提供者提供的、减少艾滋病毒/性传播感染性风险的干预措施来满足这一需求，该干预措施将在巴西的门诊心理健康公共环境中实施，这将：1）建立诊所的能力，以帮助在其照顾下的家庭更舒适地解决青少年的性问题; 2）促进青年的安全性行为;减少有心理健康问题的青少年的HIV/STI危险性行为。从拟议项目中吸取的经验教训可能会为巴西和其他地方的功效试验和干预措施的实施提供信息。