An interactive, narrative intervention to address the mental health treatment gap among young people living with HIV in Nigeria

一种互动式叙事干预措施，旨在解决尼日利亚艾滋病毒感染者年轻人的心理健康治疗差距

• 批准号: 10311346
• 负责人: Aimalohi Ahonkhai
• 金额: $ 21.62万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10311346
• 关键词: Address; Adherence; Adolescent; Adopted; Africa; Africa South of the Sahara; African; Appointment; COVID-19; Car Phone; Caregivers; Caring; Cause of Death; Climate; Clinic; Consolidated Framework for Implementation Research; Country; Development; Diagnosis; Disease remission; Distress; Effectiveness; Emotional; Epidemic; Epidemiology; Exploratory/Developmental Grant; Funding Opportunities; Future; General Population; Goals; HIV; HIV Seronegativity; Health; Health Professional; Health Promotion; Health Services Accessibility; Health Technology; Healthcare; Home; Individual; Interdisciplinary Study; Intervention; Knowledge; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Nigeria; Nonprofit Organizations; Outcome; Ownership; Patients; Persons; Play; Population; Provider; Psychiatric Social Work; Psychotherapy; Public Health; Randomized Controlled Trials; Research; Research Personnel; Role; Side; Social Impacts; Technology; Telephone; Testing; Therapeutic Intervention; Training; Treatment outcome; Universities; Visit; World Health Organization; Youth; age group; antiretroviral therapy; base; care providers; comorbidity; cost; design; digital; disorder control; effectiveness implementation study; evidence base; experience; handheld mobile device; implementation science; improved; innovation; interest; low and middle-income countries; mHealth; medication compliance; mental training; multidisciplinary; novel; problem solving therapy; prototype; psychologic; psychological distress; satisfaction; screening; social cognitive theory; social stigma; stakeholder perspectives; theories; usability; virtual environment

PROJECT SUMMARY Young people living with HIV (Y-PLWH) have poor adherence to antiretroviral therapy and engagement in HIV care, making HIV the leading cause of death for African adolescents. Depression and psychological distress are much more common among Y-PLWH than in the general population, and are associated with significantly worse adherence to care and treatment when compared to Y-PLWH without these co-morbid conditions. Thus, untreated depression and severe psychological distress are important contributors to poor HIV outcomes in this population. Nigeria is home to the 4th largest HIV population globally and 10% of Y-PLWH, but mental health screening is not routinely conducted in this setting, and less than 10% of those diagnosed have access to evidence-based care. Despite this treatment gap, few interventions have targeted the mental health needs of Y-PLWH in Africa. The World Health Organization recommends that caregivers of Y-PLWH adopt youth- friendly strategies and incorporate psychosocial services to meet their needs, and that task shifting to non- specialized health workers be used to overcome the dearth of trained professionals in low and middle-income countries. Task-shifted problem Solving Therapy (PST) has been effectively used by our team and others to treat both depression and psychological distress using a task-shifted approach. However, PST is an intensive strategy (typically 6-15 weekly sessions) often delivered in-person and poor completion rates are associated with less effectiveness -- a concern further magnified during the current COVID-19 climate. Mobile health technologies may be uniquely suited to surmount some of the obstacles for effective PST delivery in Nigeria and novel digital game-based strategies, can be utilized to promote engagement in mental health interventions on a platform that is compelling for young people. Our team has developed, a preliminary prototype of a theory-grounded game, Change My Story, in which players navigate difficult experiences based on drivers of psychological distress and interact with a virtual environment to choose a narrative path toward the story's conclusion. In this proposal, we will finalize the prototype of Change My Story, and integrate this game into a comprehensive, task-shifted PST intervention delivered via mobile phone to optimize engagement in mental health care. Through the R21 mechanism, we aim to: 1) finalize the Change My Story prototype to address key drivers of psychological distress among Y-PLWH in Nigeria and 2) establish the usability, feasibility, and acceptability of Change My Story among Y-PLWH with psychological distress in Nigeria. Through the R33 mechanism, we aim to 1) conduct a hybrid implementation-effectiveness pilot RCT for 80 Y-PLWH with depression or psychological distress, and compare feasibility, acceptability, engagement, satisfaction and preliminary effectiveness among individuals receiving PST alone or PST with Change My Story, and 2) use the Consolidated Framework for Implementation Research (CFIR) to assess factors influencing engagement, acceptability, and satisfaction along with facilitators and barriers to implementation delivery.

项目总结 青年艾滋病毒携带者(Y-PLWH)对抗逆转录病毒治疗的依从性和对艾滋病毒的参与度较低 这使得艾滋病毒成为非洲青少年死亡的主要原因。抑郁与心理困扰 在Y-PLWH中比在普通人群中更常见，并与显著相关 与没有这些共病情况的Y-PLWH相比，对护理和治疗的依从性更差。 因此，未经治疗的抑郁症和严重的心理困扰是导致艾滋病毒结果不佳的重要因素。 在这群人中。尼日利亚是全球第四大艾滋病毒感染者和10%的Y-PLWH患者，但精神疾病 在这种情况下，通常不会进行健康筛查，只有不到10%的确诊患者可以进行筛查 以证据为基础的护理。尽管存在这种治疗差距，但很少有针对心理健康需求的干预措施 在非洲的Y-PLWH。世界卫生组织建议Y-PLWH的照顾者收养年轻人- 友好战略和纳入心理社会服务，以满足他们的需求，这项任务转移到非 使用专门的卫生工作者来克服中低收入者缺乏训练有素的专业人员 国家。任务转移问题解决疗法(PST)已经被我们的团队和其他人有效地用于 用任务转换的方法来治疗抑郁症和心理困扰。然而，PST是一种密集的 策略(通常为每周6-15次会议)通常面对面交付，完成率较低 效果不佳--这一担忧在当前的新冠肺炎环境下进一步放大。移动医疗 技术可能是唯一适合于克服尼日利亚有效提供PST的一些障碍的技术 和新的基于数字游戏的策略，可以被用来促进参与心理健康干预 在一个对年轻人有吸引力的平台上。我们团队已经开发了一个初步的原型， 基于理论的游戏，改变我的故事，在游戏中，玩家基于驱动程序来导航困难的经历 心理痛苦，并与虚拟环境互动，选择一条通往故事的叙事路径 结论。在这个提案中，我们将最终确定Change My Story的原型，并将这款游戏整合到一个 通过移动电话提供全面的、任务转移的PST干预，以优化心理投入 医疗保健。通过R21机制，我们的目标是：1)最终确定将My Story原型更改为Address Key 尼日利亚青年妇幼保健院心理困扰的驱动因素2)建立可用性、可行性和 尼日利亚心理困扰的青年妇女会接受《改变我的故事》。通过R33 机制，我们的目标是：1)对80个年青人-长春期医院进行一项混合实施-有效性试验RCT， 抑郁或心理困扰，并比较可行性、可接受性、参与度、满意度和 单独接受PST或PST与Change My Story一起接受的个人的初步有效性，以及2)使用 实施研究综合框架(CFIR)，以评估影响参与度的因素， 可接受性、满意度以及执行交付的促进者和障碍。