Suubi4Her: A Combination Intervention Addressing HIV Risk Behaviors Among Older Adolescent Girls Transitioning into Adulthood in Uganda

Suubi4Her：针对乌干达成年期大龄少女的艾滋病毒危险行为的联合干预措施

• 批准号: 9892186
• 负责人: FRED M SSEWAMALA
• 金额: $ 18.36万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9892186
• 关键词: 12 year old; 17 year old; 19 year old; AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Adult; Affect; Africa South of the Sahara; Age; Anxiety; Behavioral; Biological; Businesses; Child; Chlamydia; Cognitive; Communication; Communities; Data; Data Collection; Development; Economics; Education; Effectiveness; Enrollment; Exhibits; Exposure to; Family; Family Relationship; Feeling hopeless; Female; Female Adolescents; Financial Hardship; Fostering; Gender; Gonorrhea; HIV; HIV Infections; HIV risk; Health; Health behavior; Health education; Home environment; Incentives; Infection; Intervention; Marriage; Measures; Mediating; Mediation; Mental Depression; Mental Health; Mental disorders; Outcome; Patient Self-Report; Population; Poverty; Prevalence; Prevention approach; Primary Schools; Process; Public Health; Randomized; Reporting; Research; Resources; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Safe Sex; Safety; Savings; Schools; Secondary Schools; Security; Self Efficacy; Sex Behavior; Sex Education; Sexual Health; Sexually Transmitted Diseases; Student Dropouts; Testing; Time; Training; Treatment Efficacy; Trichomonas; Uganda; United States National Institutes of Health; Viral Load result; Vulnerable Populations; Youth; base; behavioral health; child depression; cost; cost-effectiveness evaluation; emerging adult; empowerment; evidence base; girls; group intervention; high risk sexual behavior; improved; indexing; innovation; intimate partner violence; prevent; programs; protective behavior; public health relevance; secondary outcome; self esteem; sex; sexual risk taking; stressor; theories; young adult; young woman

Aligned with the NIH priority of addressing disparities in new HIV infections and the UNAIDS call for implementing combination HIV prevention approaches, the proposed study will examine the impact and cost associated with Suubi4Her, an innovative combination intervention that aims to prevent HIV risk behaviors among 15-17 year-old girls living in communities heavily affected by poverty and HIV/AIDS in Uganda. In sub- Saharan Africa (SSA), family financial stress can compromise the support available to adolescents, with girls living in poverty exhibiting higher rates of risky sexual behavior increasing their vulnerability in acquiring HIV and other STIs. At the same time, internalizing mental health disorders such as depression and low self- esteem disproportionately affect girls and may be contributing to HIV risk behavior. Against that backdrop, support over and above health and sex education is needed to help adolescent girls in SSA successfully transition into young adulthood. The proposed study is informed by two previously tested interventions – asset- based matched savings accounts (YDA) and family strengthening through Multiple Family Groups (MFG) which have successfully been implemented with younger primary school-going adolescents. Suubi4Her will test the theory that youth cognitive and behavioral change is influenced by economic stability while examining if enhanced intra-familial support and communication are needed to maintain positive behavioral health functioning and reinforce engagement in protective health behaviors. Nested within 42 secondary schools across four districts of Uganda heavily impacted by HIV/AIDS, 1260 older girls (ages 15-17 at enrollment) will be randomly assigned (at school level) to one of three study conditions: 1) Savings (Youth Development Accounts - YDA)- with a 1:1 incentive match rate – for education and microenterprise development; 2) Savings (YDA) + MFG intervention; 3) Control condition receiving standard health and sex education provided in schools. The intervention will be provided for 24 months. Assessments at baseline,12, 24, and 36-months will include biomedical data to measure our primary sexual-risk outcome:1) proportion of girls' biologically confirmed STIs (Gonorrhea, Trichomonas and Chlamydia); and secondary outcomes: 2) the proportion of new HIV infections during the study period, and 3) for HIV+ girls, viral load and CD4 as markers of ART adherence. The study aims are to: 1) Examine whether the Suubi4Her intervention is effective in protecting adolescent girls against known HIV risk factors (including economically-motivated sex and intimate partner violence). 2) Elucidate the effects of the Suubi4Her intervention on behavioral health functioning (i.e., depression, self- efficacy and hopelessness) and examine the effects of these variables as potential mechanisms of change, mediating the relationship between each intervention and HIV risk reduction. 3) Evaluate the cost-effectiveness of each intervention condition. The study will also use the Child Depression Index and Beck Hopelessness Scale to examine the efficacy of interventions in improving mental health in this vulnerable population.

与 NIH 解决新发 HIV 感染差异问题的优先事项以及 UNAIDS 的呼吁保持一致 实施艾滋病毒综合预防方法，拟议的研究将检查其影响和成本 与 Suubi4Her 相关，这是一种旨在预防艾滋病毒危险行为的创新组合干预措施 生活在乌干达受贫困和艾滋病毒/艾滋病严重影响的社区的 15 至 17 岁女孩中。在子 撒哈拉非洲（SSA），家庭经济压力可能会影响青少年和女孩获得的支持 生活在贫困中的危险性行为发生率较高，增加了他们感染艾滋病毒的脆弱性 和其他性传播感染。与此同时，内化精神健康障碍，如抑郁和低自尊。 尊重对女孩的影响尤为严重，并可能导致艾滋病毒危险行为。在此背景下， 为了成功帮助撒哈拉以南非洲地区的少女，需要健康和性教育以外的支持 过渡到青年时期。拟议的研究以两种先前测试的干预措施为基础——资产- 基于匹配的储蓄账户（YDA）和通过多个家庭团体（MFG）加强家庭实力 这些措施已在年龄较小的小学青少年中成功实施。 Suubi4她的意志 检验青年认知和行为变化受经济稳定性影响的理论，同时考察 是否需要加强家庭内部支持和沟通以保持积极的行为健康 发挥作用并加强对保护性健康行为的参与。坐落于 42 所中学内 在乌干达受艾滋病毒/艾滋病严重影响的四个地区，1260 名年龄较大的女孩（入学时年龄为 15-17 岁）将 被随机分配（在学校层面）以下三种学习条件之一： 1) 储蓄（青少年发展） 账户 - YDA）- 具有 1:1 的激励匹配率 - 用于教育和微型企业发展； 2) 储蓄 (YDA) + MFG 干预； 3) 控制接受标准健康和性教育的情况 学校。干预将提供 24 个月。基线、12、24 和 36 个月的评估将 包括生物医学数据来衡量我们的主要性风险结果：1) 女孩的生物学比例 确诊的性传播感染（淋病、滴虫和衣原体）；和次要结果：2）新的比例 研究期间的 HIV 感染，以及 3) 对于 HIV+ 女孩，病毒载量和 CD4 作为 ART 依从性的标志。 该研究的目的是： 1) 检验 Suubi4Her 干预是否能有效保护青少年 女孩免受已知的艾滋病毒危险因素（包括出于经济动机的性行为和亲密伴侣暴力）。 2） 阐明 Suubi4Her 干预对行为健康功能（即抑郁、自我 有效性和绝望）并检查这些变量作为潜在变化机制的影响， 调解每项干预措施与降低艾滋病毒风险之间的关系。 3）评估成本效益 每个干预条件。该研究还将使用儿童抑郁指数和贝克绝望指数 衡量干预措施在改善这一弱势群体心理健康方面的效果。