Growing Up: Intervening with HIV-Positive Adolescents in Resource-Poor Settings

成长：在资源匮乏的环境中对艾滋病毒阳性青少年进行干预

• 批准号: 9281017
• 负责人: JESSY G DEVIEUX
• 金额: $ 18.75万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-25 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9281017
• 关键词: 15 year old; 19 year old; AIDS prevention; AIDS/HIV problem; Adherence; Adolescence; Adolescent; Adult; Affect; Africa South of the Sahara; Anti-Retroviral Agents; Antiretroviral resistance; Attention; Back; Behavior; Behavioral; CD4 Lymphocyte Count; Caregivers; Caribbean region; Caring; Child; Childhood; Chronic Disease; Clinic; Clinical; Cognitive; Cognitive Therapy; Communication; Country; Data; Development; Developmental Delay Disorders; Diagnosis; Disease; Distress; Economics; Education; Educational workshop; Elements; Epidemic; Evidence based intervention; Exposure to; Failure; Focus Groups; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; HIV-infected adolescents; Haiti; Haitian; Health; Health Care Costs; Health Personnel; Health Promotion; Incidence; Inferior; Intervention; Interview; Joints; Manuals; Measures; Methods; Modeling; Monitor; Moods; Morbidity - disease rate; Motivation; Outcome; Parents; Patients; Perinatal; Population; Prevalence; Preventive; Procedures; Protocols documentation; Psychometrics; Psychosocial Assessment and Care; Psychosocial Factor; Randomized Controlled Trials; Recruitment Activity; Regimen; Reporting; Reproductive Health; Research; Resources; Risk; Risk Behaviors; Risk Reduction; Role; Services; Severities; Sex Behavior; Sexual Partners; Stress; Testing; Training; Translating; Treatment Cost; Treatment outcome; Unsafe Sex; Viral Load result; Work; Youth; antiretroviral therapy; arm; base; cohort; cost; evidence base; experience; improved; improved outcome; innovation; low and middle-income countries; low income country; mortality; pediatric human immunodeficiency virus; pediatric human immunodeficiency virus infection; preference; primary caregiver; programs; psychological distress; public health relevance; response; scale up; skills; skills training; study population; therapy adherence; transmission process; treatment adherence; trial comparing; virology

 DESCRIPTION (provided by applicant): As pediatric HIV infection has shifted from being a fatal disease to a chronic illness, a growing cohort of young people are moving through adolescence with all the challenges of the adult HIV-infected population but largely without comparable treatment outcomes or an evidence base to improve adherence to antiretroviral treatment (ART) and preventive behavior. Despite overall declines in HIV incidence and mortality since the ART scale-up, both have risen among youth. The goal of the proposed 3-year R34 developmental study is to respond to this need for tailored research, in particular among HIV+ older adolescents, and contribute to understanding the added value in resource-limited settings of including caregivers in an adherence and risk reduction program. Although caregiver involvement is a recognized correlate of outcomes in HIV+ youth, there are no rigorous studies of the role of caregivers in outcomes among HIV+ older adolescents. This project will integrate caregiver involvement and cognitive behavioral intervention (CBI) elements to improve ART adherence and HIV risk reduction for HIV+ older adolescents treated in resource-poor clinical settings. Our proposed study population will include caregivers and 15 to 19 year-old HIV+ youth who know their status and are receiving ART in Port-au-Prince, Haiti. Guided by the theoretical framework of the developmentally sensitive Information-Motivation-Behavioral Skills for Pediatric Adherence (IMB-PED), we will develop Growing Up (N'ap Grandi, in Haitian Creole) as a collaborative model of caregiver-adolescent engagement in the key informational, motivational, and behavioral skills antecedents of ART adherence and risk reduction. The proposed study partners with Haiti's largest youth health provider, FOSREF, and builds upon prior work with HIV+ youth and adults in Port-au-Prince. The study will utilize qualitative and quantitative methods to: identify barriers and facilitators to adherence and risk reduction (Aim 1); develop and pretest N'ap Grandi, including developmentally-appropriate manuals, training materials, procedures, and psychometric adequacy of measures (Aim 2); and assess feasibility and preliminary efficacy in a 3-arm randomized controlled trial (RCT), in which 120 youth will be assigned to three groups: the experimental caregiver-adolescent N'ap Grandi, an adolescent-only version (N'ap Grandi-A) and an adolescent-only health promotion group (HP-A), examining ART adherence and virologic response, HIV risk behaviors, positive communication and monitoring, stress and mood, and costs from the health center perspective (Aim 3). Isolation, inhibited communication, caregiver distress, adolescent ART non-adherence and HIV risk are very high in Haiti, which is a microcosm of the global pediatric HIV epidemic in low and middle income countries (LMICs) with generalized epidemics. After sub- Saharan Africa, the Caribbean is the most HIV-affected region in the world, with 50% of people with HIV infection living in Haiti. Our proposed study will be the first tailored intervention and RCT pilotd for HIV+ adolescents in Haiti, and will represent one of only a handful in LMICs globally.

 描述（由适用提供）：由于小儿艾滋病毒感染已从致命疾病转变为慢性病，越来越多的年轻人正在经历青少年的群体，而成人HIV感染的人群的所有挑战都在很大程度上，但在很大程度上没有可比的治疗结果或证据基础，以改善对抗雷毒素治疗的依恋基础（抗雷雷神治疗（Art）和预防性（艺术）和预防性行为。尽管自艺术扩大以来的艾滋病毒发病率和死亡率的总体下降，但两者都在青年中崛起。拟议的3年R34发展研究的目的是应对对量身定制的研究的需求，尤其是在艾滋病毒+老年青少年中，并有助于理解在资源有限的环境中增加的价值，即在遵守和降低风险计划中包括护理人员。尽管护理人员的参与是艾滋病毒+青年结果的公认相关性，但尚无对护理人员在艾滋病毒+老年青少年中结果中的作用进行严格的研究。该项目将整合护理人员的参与和认知行为干预（CBI）元素，以改善在资源贫乏的临床环境中接受治疗的HIV+老年青少年的ART青少年和HIV风险降低。我们拟议的研究人群将包括看护人和15至19岁的艾滋病毒+青年，他们知道自己的地位并正在海地港口王位接受艺术。 Guided by the theoretical framework of The developedally sensitive Information-Motivation-Behavioral Skills for Pediatric Adherence (IMB-PED), we will develop Growing Up (N'ap Grandi, in Haitian Creole) as a collaborative model of caregiver-adolescent engagement in the key informational, motivational, and behavioral skills antecedents of ART adherence and risk reduction.拟议的研究与海地最大的健康提供商Fosref合作，并在与艾滋病毒+青年和成人的先前工作基础上建立了合作伙伴。该研究将利用定性和定量方法来：确定障碍和促进者遵守和降低风险（AIM 1）；开发和预测的n'ap grandi，包括制定和适当的手册，培训材料，程序和心理测量措施的充分性（AIM 2）；在三臂随机对照试验（RCT）中的评估和评估可行性和初步效率，其中120名年轻人将分配给三组：实验性照顾者 - 青少年n'ap Grandi，仅青少年版本（N'AP Grandi-A），AP-Grandi-A），是青少年的唯一健康促进型和风险的促进ARTORGION ARTORGION RENSTIC ARTOLICT ARTORIGY ARTORIGY ARTOLITION RENSTIC ARTOLIC ARTOLIC ARTOLITION，病毒性响应，病毒性响应，病毒性，病毒性，HP-A），HP-A从健康中心的角度来看（目标3）。海地的隔离，抑制交流，照顾者的困扰，青少年艺术不遵守和艾滋病毒风险非常高，这是具有广义流行病学的低收入和中等收入国家（LMIC）全球小儿艾滋病毒流行的缩影。在撒哈拉以南非洲之后，加勒比海是世界上受艾滋病毒影响最大的地区，有50％的艾滋病毒感染居住在海地。我们拟议的研究将是海地中首次针对HIV+青少年的量身定制的干预措施和RCT飞行员，并且将代表全球少数LMIC的少数。