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

将心理健康纳入艾滋病毒诊所，以改善坦桑尼亚青年的治疗结果

• 批准号: 8815436
• 负责人: Dorothy E. Dow
• 金额: $ 13.51万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8815436
• 关键词: Academic Medical Centers; Address; Adherence; Adolescence; Adolescent; Adult; Age; Behavior; Behavioral; Biometry; Caring; Child; Childhood; Chronic stress; Clinic; Clinical Psychology; Clinical Trials; Cognitive; Cognitive Therapy; Collaborations; Communicable Diseases; Comorbidity; Data; Development Plans; Disclosure; Disease; Educational Curriculum; Emotional; Enrollment; Event; Faculty; Feasibility Studies; Focus Groups; Future; Gender; Goals; Grant; Group Therapy; HIV; HIV Seropositivity; HIV-1; HIV-infected adolescents; Hair; Health; Health Personnel; Health Policy; Health Professional; Health education; High Prevalence; Institutes; Intervention; Language; Lead; Life; Master of Science; Measures; Medical; Medical center; Mental Depression; Mental Health; Mental Health Services; Mentors; Mentorship; Modeling; Morbidity - disease rate; Orphan; Outcome; Participant; Pediatrics; Pharmaceutical Preparations; Physicians; Prevalence; Prevention; Professional counselor; Protocols documentation; Psychiatrist; Psychologist; Psychotherapy; Questionnaires; RNA; Randomized; Randomized Controlled Trials; Reporting; Research; Research Methodology; Research Personnel; Resources; Risk; Sampling; Sexuality; Site; Stress; Structure; Symptoms; Tanzania; Teenagers; Therapeutic; Training; Training Programs; Translating; Trauma; Treatment Efficacy; Universities; Viral; Vulnerable Populations; Work; Youth; age group; antiretroviral therapy; base; career; career development; clinical care; common treatment; depressive symptoms; design; evidence base; experience; global health; health inequalities; improved; interdisciplinary approach; meetings; mortality; multidisciplinary; novel; patient oriented research; physical conditioning; post-traumatic stress; professor; programs; psychologic; psychosocial; public health relevance; scale up; sexual HIV transmission; sexually active; skills; skills training; therapy adherence; tool; trial design

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.

描述（由申请人提供）：多萝西·道博士拥有全球健康科学硕士学位，将于2014年7月成为杜克大学医学中心儿科传染病部的初级教师。近三年来，她一直在坦桑尼亚的莫希生活和工作。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。在杜克大学和基利曼哈罗基督教医疗中心（KCMC）的艾滋病毒诊所期间，道博士逐渐意识到这句话的现实，“没有心理健康就没有健康。“她的初步研究评估了坦桑尼亚艾滋病毒阳性青少年心理健康困难的流行情况，结果表明，抑郁和创伤的症状在当地艾滋病毒青年诊所很普遍。尽管有这些发现，目前KCMC没有心理学家或精神病学家。这一拟议的职业发展计划包括一个多学科的五年计划，包括全球心理健康，研究方法和试验设计，先进的生物统计学以及实施大型临床试验的管理技能的教学培训。这些教学方法与指导性的、以患者为导向的 研究经验设计，调整，并在艾滋病毒青少年诊所实施心理健康干预。陶氏博士将接受科琳坎宁安博士的指导（儿科传染病和儿科全球健康主任），Karen奥唐纳博士（临床心理学），博士凯瑟琳惠顿（卫生政策和不平等研究中心主任），Blandina Mmbaga博士（共同网站负责人KCMC-杜克大学合作，儿科教授），和顾问博士约翰巴特利特（杜克全球健康研究所，DGHI）和凯瑟琳·西科马博士（临床心理学）。道博士建议将艾滋病毒教育课程和强化认知行为疗法（CBT）和称为SPARCS的生活技能培训计划纳入艾滋病毒青少年诊所。第一个目标是制作一个工具包，对艾滋病毒教育课程和SPARCS进行调整，使其具有文化相关性并使用斯瓦希里语。第二个目标是进行可行性研究，以确定SPARCS是否改善了心理健康，依从性和病毒结果。根据Dow博士的导师在坦桑尼亚孤儿中成功实施以创伤为重点的CBT的工作，预计SPARCS在资源有限的环境中也是可行的。假设是，通过解决心理健康需求，青年将表现出更好的抗逆转录病毒治疗依从性和改善病毒学结果。预计该项目将改善坦桑尼亚艾滋病毒阳性青少年的身心健康，并就这一背景下的心理健康困难展开对话讨论。在完成这项可行性研究和进一步的教学和指导后，候选人计划提交R 01赠款，以评估这种干预措施作为随机对照试验的有效性，实现她进行独立的全球健康研究的目标，以改善生活在坦桑尼亚和其他资源有限环境中的青少年的整体健康。