Integrating Mental Health into a HIV Clinic to Improve Outcomes in Tanzanian Youth

Dorothy Dow博士拥有全球健康理学硕士学位，将于2014年7月成为杜克大学医学中心儿科传染病科的初级教师。近三年来，她一直在坦桑尼亚的Moshi生活和工作。她的长期目标是成为一名独立的全球健康研究人员，将心理健康纳入青少年艾滋病毒的预防和治疗中。在杜克大学和乞力马扎罗山基督教医学中心（KCMC）的艾滋病门诊期间，道博士逐渐意识到“没有精神健康就没有健康”这句话的现实。她的初步研究评估了坦桑尼亚艾滋病毒阳性青少年中心理健康问题的普遍程度，结果表明，当地艾滋病毒青年诊所普遍存在抑郁和创伤症状。尽管有这些发现，目前在KCMC没有心理学家或精神科医生。这项拟议的职业发展计划包括一个多学科的五年计划，其中包括全球心理健康、研究方法和试验设计、高级生物统计学和实施大型临床试验的管理技能方面的教学培训。这些教学与有指导的、以病人为导向的教学密切相关

DESCRIPTION (provided by applicant): Dr. Dorothy Dow has a Master's of Science in Global Health and will become junior faculty at Duke University Medical Center in the Division of Pediatric Infectious Diseases in July 2014. For nearly three years, she has been living and working in Moshi, Tanzania. Her long-term goal is to become an independent global health researcher integrating mental health into the prevention and treatment of HIV among adolescents. During HIV clinic both at Duke University and Kilimanjaro Christian Medical Centre (KCMC), Dr. Dow has come to realize the reality of the statement, "no health without mental health." Her preliminary research evaluating the prevalence of mental health difficulties among HIV-positive adolescents in Tanzania has demonstrated symptoms of depression and trauma are prevalent in the local HIV youth clinic. Despite these findings, there are no psychologists or psychiatrists currently available at KCMC. This proposed career development plan incorporates a multidisciplinary five-year program complete with didactic training in global mental health, research methods and trial design, advanced biostatistics, and management skills for implementing large clinical trials. These didactics closely align with a mentored, patient-oriented research experience designing, adapting, and implementing a mental health intervention in the HIV adolescent clinic. Dr. Dow will receive mentorship from Dr. Coleen Cunningham (Chief, Pediatric Infectious Diseases and Pediatric Global Health), Dr. Karen O'Donnell (Clinical Psychology), Dr. Kathryn Whetten (Director of the Center for Health Policy and Inequalities Research), Dr. Blandina Mmbaga (Co-Site leader KCMC-Duke Collaboration, Professor of Pediatrics), and consultants Dr. John Bartlett (Duke Global Health Institute, DGHI) and Dr. Kathleen Sikkema (Clinical Psychology). Dr. Dow proposes to integrate both a HIV educational curriculum and an intensive cognitive behavioral therapy (CBT) and life skills training program called SPARCS, into the HIV teen clinic. The first aim is to create a tool kit by adapting both a HIV educational curriculum and SPARCS to be culturally relevant and in Swahili language. The second aim is a feasibility study to determine if SPARCS improves mental health, adherence, and viral outcomes. Based on the work of Dr. Dow's mentors who have successfully implemented trauma-focused CBT among orphans in Tanzania, it is anticipated that SPARCS will also be feasible to implement in a resource-limited setting. The hypothesis is that by addressing mental health needs, youth will demonstrate improved ART adherence and improved virologic outcomes. This project is anticipated to improve both mental and physical health of HIV-positive adolescents in Tanzania and open a dialogue of discussion around mental health difficulties in this setting. Upon completion of this feasibility study and further didactics and mentorship, the candidate plans to submit a R01 grant to evaluate the efficacy of this intervention as a randomized controlled trial, fulfilling her goal of conducting independent global health research to improve the overall health of adolescents living in Tanzania and other resource-limited settings.