Improving Adherence Among HIV+ Rwandan Youth: A TI-CBTe Indigenous Leader Model

提高艾滋病毒卢旺达青年的依从性：TI-CBTe 土著领袖模型

• 批准号: 8601541
• 负责人: Mardge H Cohen
• 金额: $ 46.2万
• 依托单位: HEKTOEN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8601541
• 关键词: 21 year old; 6 year old; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Adolescent and Young Adult; Adult; Africa South of the Sahara; Age; Anti-Retroviral Agents; Attitude; Caregivers; Caring; Clinic; Cognitive Therapy; Comorbidity; Complex; Country; Data; Distress; Economics; Ensure; Epidemic; Evidence based intervention; Face; Feeling hopeless; Forcible intercourse; Future; Gender; Gender Role; Goals; HIV; Health; Health Priorities; Indigenous; Infection; Intervention; Left; Life; Life Expectancy; Link; Logistics; Measurement; Mediator of activation protein; Medical center; Medicine; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Noise; Outcome; Parents; Participant; Patient Self-Report; Perinatal; Pharmaceutical Preparations; Population; Prevalence; Productivity; Provider; Psychologist; Psychosocial Assessment and Care; Quality of life; Randomized; Reporting; Research; Research Infrastructure; Resources; Rwanda; Services; Sex Behavior; Site; Survivors; Target Populations; Techniques; Testing; Time; Training; Trauma; Treatment outcome; Violence; Viral; Viral Load result; Virus; Woman; Youth; antiretroviral therapy; arm; base; comparative efficacy; experience; follow-up; global health; improved; innovation; medication compliance; meetings; mortality; multidisciplinary; outreach; pill; programs; public health relevance; resistant strain; role model; sexual violence; transmission process; treatment as usual; treatment strategy

DESCRIPTION (provided by applicant): Like most of sub-Saharan Africa, Rwandan youth are the epicenter of the AIDS epidemic, accounting for 40% of new infections. Antiretroviral (ART) adherence is a global health priority, but Rwandan youth are more than twice as likely to be on second line therapy as adults, and with a median population age of 18.7 years old, adherence is essential for Rwanda's future. Resources to provide youth-centered medical and psychosocial care are limited in Rwanda, and young people with HIV face many obstacles to adherence, namely the long-term consequences of genocide, depression, and gender-based violence, as well as logistical issues, negative attitudes, and insufficient parent/caregiver support. Preliminary data underscore the utility of culturally-adapted, trauma-informed cognitive behavioral therapy (TI-CBT) in reducing depression and traumatic distress among youth and adults in Rwanda. This project proposes a 2-arm RCT to test and compare the efficacy of adherence-enhanced TI-CBT (i.e., TI-CBTe) to usual care in increasing ART adherence among 350 Rwandan 14 - 21 year olds from the two clinics caring for the largest number of youth with HIV in Rwanda. Based on the Indigenous Leader Outreach Model, we will train 20 HIV+ indigenous youth leaders who are > 95% ART adherent (IYL) and supervising psychologists to deliver the intervention. Youth, caregivers, and IYL will complete baseline, 6-, and 12-month follow-up assessments to assess effects on adherence and important mediators (trauma, depression, gender-based violence). We will use an intent-to-treat analysis and a combination of regression techniques and other inferential statistical tests for contrasting means and proportions. We will analyze treatment outcomes using logistic and linear multiple regression models examining effects at 6- and 12- months separately, as well as a combined model with random effects for repeated measurements across time. This proposal answers a compelling need for innovative programs to increase ART adherence among HIV+ youth. If effective, the study will build Rwanda's capacity to provide much needed services; and, involvement by the Rwanda Biomedical Center will ensure wide dissemination.

描述（由申请人提供）：与撒哈拉以南非洲的大多数国家一样，卢旺达青年是艾滋病流行的中心，占新感染人数的40%。坚持抗逆转录病毒治疗是全球卫生的优先事项，但卢旺达青年接受二线治疗的可能性是成年人的两倍多，而且人口年龄中位数为18.7岁，坚持治疗对卢旺达的未来至关重要。在卢旺达，提供以青年为中心的医疗和心理社会护理的资源有限，感染艾滋病毒的青年在坚持治疗方面面临许多障碍，即种族灭绝、抑郁症和基于性别的暴力的长期后果，以及后勤问题、消极态度和父母/照顾者支持不足。初步数据强调了文化适应，创伤认知行为疗法（TI-CBT）在减少卢旺达青年和成年人的抑郁和创伤性痛苦方面的效用。该项目提出了一项2组RCT，以测试和比较依从性增强TI-CBT的疗效（即，TI-CBTe）的常规护理，以提高卢旺达两个诊所的350名14 - 21奥尔兹的年轻人对抗逆转录病毒疗法的坚持率，这两个诊所照顾卢旺达人数最多的艾滋病毒感染者。根据土著领导人外联模式，我们将培训20名艾滋病毒阳性的土著青年领导人，他们的抗逆转录病毒疗法坚持率超过95%，并监督心理学家提供干预措施。青少年、护理人员和IYL将完成基线、6个月和12个月的随访评估，以评估对依从性和重要介质（创伤、抑郁、性别暴力）的影响。我们将使用意向治疗分析和回归技术与其他推论统计检验的组合来对比平均值和比例。我们将使用logistic和线性多元回归模型分析治疗结局，分别检查6个月和12个月的效果，以及一个组合模型，其中随机效应用于跨时间重复测量。该提案回应了对创新计划的迫切需求，以增加艾滋病毒+青年的抗逆转录病毒治疗依从性。如果有效，该研究将建立卢旺达提供急需服务的能力;卢旺达生物医学中心的参与将确保广泛传播。