Adaptation and optimization of the Friendship Bench mental health intervention for adolescent girls and young women in South African PrEP delivery settings

南非 PrEP 分娩环境中针对少女和年轻女性的友谊长凳心理健康干预的调整和优化

• 批准号: 10818234
• 负责人: Jennifer Velloza
• 金额: $ 11.05万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-11 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10818234
• 关键词: AIDS prevention; Accounting; Address; Adherence; Africa South of the Sahara; African; Age; Anxiety; Client; Clinic; Cognitive Therapy; Complex; Comprehension; Consensus; Coping Behavior; Country; Data; Data Analyses; Data Collection; Effectiveness; Elements; Evaluation; Face; Female Adolescents; Friendships; Funding; Goals; HIV; High Risk Woman; Hybrids; Incidence; Individual; Intervention; Measurement; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; National Institute of Mental Health; Outcome; Parents; Participant; Persons; Population; Positioning Attribute; Preparation; Prevention approach; Problem Solving; Process; Professional counselor; Provider; Publishing; Research; Research Activity; Research Personnel; Risk; Sample Size; Sampling; Social Behavior; South Africa; South African; Standardization; Stress; Testing; Therapeutic Intervention; Training; Woman; Work; Youth; Zimbabwe; antiretroviral therapy; cognitive interview; common symptom; effectiveness evaluation; effectiveness/implementation trial; evidence base; health care delivery; human centered design; implementation cost; implementation intervention; implementation outcomes; implementation science; implementation strategy; implementation trial; improved; informant; intervention delivery; member; parent project; pre-exposure prophylaxis; prevent; problem solving therapy; programs; research study; response; satisfaction; scale up; service delivery; success; systematic review; theories; therapy adherence; treatment adherence; validation studies; virtual; young woman

ABSTRACT African adolescent girls and young women (AGYW) face high rates of HIV and common mental disorders. HIV pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention approach which is being scaled up in South Africa. However, symptoms of common mental disorders are significant barriers to PrEP use. Effective mental health treatment, such as problem-solving therapy (PST), has the potential to be integrated with PrEP delivery to address mental health challenges and modifiable barriers to PrEP use and improve PrEP adherence for AGYW. The Friendship Bench is a promising evidence-based PST intervention option for AGYW in PrEP settings given that it was developed for delivery in busy HIV clinics, is currently being scaled-up in South Africa, and preliminary data suggests it can be adapted to improve HIV treatment adherence among African women. Research is needed to evaluate its effectiveness on mental health and PrEP adherence outcomes and identify implementation strategies for AGYW in PrEP delivery settings. In a prior K99 study (K99 MH123369), Dr. Velloza and her team conducted human-centered design work to understand needs around integrated mental health and PrEP intervention delivery and to adapt the Friendship Bench intervention and implementation strategies. The overall goal of the current R00 study (R00 MH123369) is to test and optimize the adapted Friendship Bench for African AGYW in PrEP delivery. The Specific Aims are to conduct a hybrid Type II implementation-effectiveness trial to assess preliminary effectiveness of Youth Friendship Bench SA on PrEP adherence and mental health while optimizing implementation for cost constraints in PrEP delivery (Aim 1) and identify themes around intervention acceptability, appropriateness, and feasibility (Aim 2). In preparation for Aim 2 of this work, we conducted a systematic review of acceptability metrics and met with key leaders in the HIV and implementation science fields to discuss measurement approaches for these early implementation outcomes. We found significant gaps in high quality acceptability, appropriateness, and feasibility metrics and a lack of standardization in how these constructs are operationalized in HIV-related research specifically and the field of implementation science more broadly. These gaps have prevented us from conducting Aim 2 data collection and analyses. This 12-month supplement application proposes to enhance the existing parent project by identifying and validating acceptability, appropriateness, and feasibility metrics to inform Aim 2 of the parent study. We propose to leverage our current R00 study to: 1) develop a toolkit of “best practice” acceptability, appropriateness, and feasibility measures to inform Aim 2 of the parent R00 and harmonize implementation science efforts in the HIV prevention field; and 2) validate acceptability, appropriateness, and feasibility measures in the context of our PrEP implementation trial in Johannesburg. We are well-positioned to implement these newly proposed research activities, which will support and strengthen the originally approved R00 research. Our findings also have the potential to advance implementation science construct measurement in the HIV prevention field more broadly.

摘要 非洲少女和年轻妇女面临着艾滋病毒和常见精神疾病的高发病率。艾滋病毒 暴露前预防（PrEP）是一种非常有效的艾滋病毒预防方法，目前正在南苏丹推广。 非洲然而，常见精神障碍的症状是使用PrEP的重大障碍。有效的心理 健康治疗，如问题解决疗法（PST），有可能与PrEP提供相结合 解决心理健康挑战和可改变的PrEP使用障碍，并提高PrEP依从性， AGYW。友谊长凳是一个有前途的基于证据的PST干预选择AGYW在PrEP设置 鉴于它是为在忙碌的艾滋病毒诊所中分娩而开发的，目前正在南非扩大规模，并且 初步数据表明，它可以用于改善非洲妇女的艾滋病毒治疗依从性。 需要研究来评估其对心理健康和PrEP依从性结果的有效性，并确定 在PrEP提供环境中实施AGYW战略。在之前的K99研究（K99 MH 123369）中，Velloza博士 她的团队进行了以人为本的设计工作，以了解综合心理健康的需求， PrEP干预措施的实施，并调整友谊板凳干预和实施策略。的 当前R 00研究（R 00 MH 123369）的总体目标是测试和优化适应性友谊试验台， 非洲青年志愿者协会在PrEP提供方面的工作。具体目标是进行混合II型实施有效性 评估青少年友谊长凳SA对PrEP依从性和心理健康的初步有效性的试验 同时优化实施PrEP交付的成本限制（目标1），并确定围绕 干预的可接受性、适当性和可行性（目标2）。为了实现目标2，我们 对可接受性指标进行了系统审查，并会见了艾滋病毒和实施方面的主要领导人 科学领域讨论这些早期执行成果的衡量方法。我们发现 在高质量的可接受性、适当性和可行性指标方面存在重大差距，缺乏标准化 这些结构如何在艾滋病毒相关研究中具体运作， 科学更广泛。这些差距使我们无法进行目标2的数据收集和分析。这 12-一个月的补充申请建议通过识别和验证来增强现有的父项目 可接受性、适当性和可行性指标，以告知母研究的目标2。我们建议利用 我们目前的R 00研究旨在：1）开发一套“最佳实践”的可接受性、适当性和可行性工具包 采取措施，向目标2通报母R 00，并协调艾滋病毒预防方面的科学执行工作 领域; 2）在我们的PrEP背景下验证可接受性，适当性和可行性措施 在约翰内斯堡进行试验。我们有能力实施这些新提出的研究 这些活动将支持和加强最初批准的R 00研究。我们的研究结果还表明， 在更广泛的艾滋病毒预防领域推动实施科学建设衡量的潜力。