Transitioning from childhood to adulthood: the impact of perinatal HIV infection

描述(申请人提供)：随着抗逆转录病毒治疗(ART)的到来，许多感染艾滋病毒的儿童正进入青春期和青春期。然而，围产期艾滋病毒感染对从青春期到青壮年的关键发育转变的影响尚不清楚。这项拟议的研究是我们目前由NIMH资助的R01赠款在HIV+青少年和Serververter(R01MH069133；PI：Mellins)的竞争延续，非正式地称为CASAH-1(儿童和青少年自我意识和健康)。在CASAH-1中，我们正在从围产期艾滋病毒感染者和围产期艾滋病毒感染者、但未感染(血清逆转)的青年及其照顾者(9-16岁青年)和18个月随访(11-18岁青年)收集数据的最后一年。参与者最初是从纽约市的四个城市医疗中心招募的。在拟议的项目CASAH-2中，我们将研究艾滋病毒感染对危险和适应行为的影响，作为我们的弱势青年方法和过渡到青年成年的样本。我们将研究我们的健康行为理论模型--社会行动理论中的艾滋病毒感染和关键风险和保护因素如何影响可能扰乱或增强成人功能的行为结果。在CASAH-2中，青年和照顾者将在CASAH-1后续面试后1-3年重新招募。他们将在CASAH-2的另外三个后续时间点接受面谈，每个时间点间隔一年，总共进行五次CASAH-1和CASAH-2的面谈。访谈评估行为健康结果(包括情绪和行为功能、性和药物使用行为，以及受感染青少年的健康护理结果)，以及影响行为健康结果的风险和保护因素。在CASAH-2中，我们将包括与向大龄青春期和青壮年过渡特别相关的变量(例如，与学校/职业、社会关系、亲社会行为和自主性有关的功能里程碑，以及对于艾滋病毒+青年过渡到成人艾滋病毒医疗)。很少有关于围产期艾滋病毒感染的行为研究侧重于心理社会变量，也没有跟踪青年进入这一高龄范围，也很少有足够的比较组来确定围产期感染艾滋病毒的青年在青少年和青壮年不同发展阶段特有的风险和适应行为的相关性。这类研究将对美国以及低资源国家规模大得多的儿科艾滋病毒流行产生重要的干预意义。直到最近，在这些国家，获得抗逆转录病毒治疗的机会有限，导致数百万名围产期感染儿童。与公共卫生相关：在长期获得抗逆转录病毒治疗的国家，受围产期感染的青少年现在才开始进入青春期和青春期，人数相对较多。关于艾滋病毒构成的发展挑战以及阻碍或促进这些青年在接近青年成年期时获得最佳发展的因素的研究很少。这项拟议的研究将是第一次审查艾滋病毒疫情随着时间的推移对年轻人作为成年人适应社区并为社区做出贡献的能力的影响，或者反过来，由于高风险行为而构成公共卫生挑战的影响。这些发现将使我们能够为有效的教育、治疗和预防干预奠定基础，以应对在美国迅速崛起的健康和行为结果不良的新风险群体。此外，非洲、拉丁美洲和亚洲的产妇艾滋病毒疫情有增无减，感染艾滋病毒和感染艾滋病毒的儿童人数惊人，迫切需要进行研究，以便为资源有限的国家的干预措施提供信息。

DESCRIPTION (provided by applicant): With the advent of antiretroviral treatment (ART), many HIV-infected children are reaching adolescence and young adulthood. However, the impact of perinatal HIV infection on the critical developmental transition from adolescence to young adulthood is unknown. The proposed study is a competing continuation of our current NIMH funded R01 grant Mental Health and Risk Behavior in HIV+ Youths and Seroreverters (R01MH069133; PI:Mellins), informally known as CASAH-1 (Child & Adolescent Self-Awareness and Health). In CASAH-1, we are in the final year of collecting data from perinatally HIV-infected and perinatally HIV-exposed, but uninfected (seroreverter) youth, as well as their caregivers at baseline (youth ages 9-16 years) and 18-month follow-up (youth ages 11-18 years). Participants were originally recruited from four urban medical centers in NYC. In the proposed project, CASAH-2, we will study the impact of HIV infection on risk and adaptive behaviors as our sample of vulnerable youth approach and transition into young adulthood. We will examine how HIV infection and critical risk and protective factors from our theoretical model of health behavior, Social Action Theory, affect behavioral outcomes that may disrupt or enhance adult functioning. In CASAH-2, youths and caregivers will be re-recruited 1-3 years after their CASAH-1 follow-up interview. They will be interviewed at three additional follow-up time points in CASAH-2, each one year apart for a total of five interviews across CASAH-1 and CASAH-2. The interview assesses Behavioral Health Outcomes (including emotional and behavioral functioning, sexual and drug use behavior, and for infected youth, health care outcomes) as well as risk and protective factors that influence the Behavioral Health Outcomes. In CASAH-2, we will include variables that are particularly relevant for the transition to older adolescence and young adulthood, (e.g. functional milestones related to school/vocation, social relationships, pro-social conduct, and autonomy, and for the HIV+ youth, transition to adult HIV medical care). Few behavioral studies of perinatal HIV infection have focused on psychosocial variables nor have they followed youth into this older age range, and few have adequate comparison groups to identify correlates of risk and adaptive behavior unique to perinatally-infected youth across different developmental stages of adolescents and young adulthood. Such research will have important intervention implications for the US, and also for the much larger pediatric HIV epidemic in low- resource countries where, until recently, limited access to ART has resulted in millions of perinatally infected children. PUBLIC HEALTH RELEVANCE: Perinatally-infected youths are only now beginning to enter older adolescence and young adulthood in relatively large numbers in countries with longstanding access to antiretroviral treatment. Few studies exist on the developmental challenges posed by HIV and the factors that impede or promote the optimum development of these youths as they approach young adulthood. The proposed study would be one of the first of its kind to examine the impact of the HIV epidemic over time on the youths' ability to adapt and contribute to their communities as adults or conversely to pose a public health challenge as the result of high risk behavior. Findings will allow us to lay the groundwork for effective educational, therapeutic, and preventive interventions for a population fast emerging as a new risk group for poor health and behavioral outcomes in the United States (US). Furthermore, the unabated maternal HIV epidemic in Africa, Latin America, and Asia, where the numbers of HIV-infected and "HIV-affected" children are staggering, urgently warrants studies that can inform interventions in countries with limited resources.