Adverse childhood experiences and adolescent HIV risk: Causal inferences from a high HIV prevalence context

不良童年经历和青少年艾滋病毒风险：艾滋病毒高流行背景下的因果推论

• 批准号: 9359991
• 负责人: Rachel Kidman
• 金额: $ 55.66万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-26 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9359991
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adolescence; Adolescent; Adolescent HIV risk; Adult; Affect; Africa South of the Sahara; African; Age; Behavior; Behavioral; Birth; Child; Child health care; Childhood; Chronic; Contracts; Country; Data; Development; Dose; Emotional; Ensure; Epidemic; Epidemiological trend; Evaluation; Family; Family health status; Future; Government Programs; HIV; HIV Infections; HIV risk; Health; Household; Human Herpesvirus 2; Human immunodeficiency virus test; Impaired cognition; Incidence; Income; Individual; International; Intervention; Knowledge; Lead; Life Cycle Stages; Link; Longitudinal Studies; Low income; Malawi; Marriage; Measurement; Measures; Mediating; Mediator of activation protein; Mental Depression; Modeling; Outcome; Parents; Pathway interactions; Pattern; Play; Policy Maker; Population; Poverty; Prevalence; Prevention strategy; Questionnaires; Reporting; Research; Research Personnel; Resources; Risk; Role; Rural; Sampling; Sexual Health; Siblings; Social Environment; Source; Standardization; Statistical Methods; Student Dropouts; Surveys; Testing; Time; Youth; base; biological adaptation to stress; cohort; condoms; early sex initiation; experience; high risk behavior; improved; infancy; low income country; mortality; multidisciplinary; peer support; prospective; resilience; response; social; socioeconomics; tool; transmission process

Adverse childhood experiences (ACE) are potentially important and modifiable social determinants of adolescent HIV risk. While the relationship between ACE and sexual health has been documented in the US other high-income contexts with concentrated epidemics, evidence from lower-income high-HIV prevalence contexts is largely missing. Moreover, no study has considered how adversities cluster and compound across the life course, interact across ecological levels, and contribute to a common causal chain culminating in HIV infection. The proposed project will create an adolescent cohort that has been traced since birth by building on exceptional existing data provided by parents in the Malawi Longitudinal Study of Families and Health (MLSFH; established in 1998). We propose collecting two new rounds of prospective data directly from the MLSFH children as they reach adolescence; in doing so, we will establish a cohort that is currently entering a critical age-range for HIV risk as they transition to adulthood. The aims are: Aim 1. To describe the prevalence, co-occurrence and re-occurrence of Adverse Childhood Experiences among adolescents in a HIV-endemic low-income country. We will construct indicators of ACE covering the period from infancy to adolescence by linking 1) rich data captured through parental reporting in prior MLSFH waves and 2) new data collected from adolescents (at age 11-15 and at 14-18) using the Adverse Childhood Experiences – International Questionnaire (ACE-IQ) recently developed by the WHO. Aim 2. To estimate the causal impact of ACE on the emergence of differentiated HIV risk trajectories during adolescence. By applying sophisticated statistical methods, we will be able to examine the causal role of early and ongoing adversities on the emergence of HIV risk, including 1) poor transitions to adulthood 2) behavioral risk and 3) HIV and HSV2 incidence. Aim 3. To highlight potential intervention points by identifying causal mediators between ACE and HIV risk. We focus on social, emotional, and cognitive impairments that may result from frequent or chronic activation of the stress response and may also contribute to social or behavioral HIV risk. Aim 4: To identify protective factors that moderate the impact of ACE on HIV risk. We will test potential multi-level sources of resilience (e.g., family resources, peer support, government programs) that may determine how children cope could be enhanced through intervention. A rigorous evaluation of the consequences, mediators, and moderators of childhood adversity on adolescent HIV risk will greatly enhance current HIV prevention strategies in low income countries by explaining why some adolescents engage in high risk behaviors and contract HIV while others do not, and by identifying modifiable targets for intervention. By integrating the project into an ongoing longitudinal study, we rapidly create a birth cohort, facilitate causal inference, ensure timely findings, and add value to an existing, widely-used resource for research on HIV and health in sub-Saharan Africa.

不良童年经历（ACE）是潜在的重要和可改变的社会决定因素， 青少年艾滋病毒风险。虽然ACE和性健康之间的关系在美国已有记录， 其他高收入背景下的集中流行，来自低收入高艾滋病毒流行率的证据 上下文基本上缺失。此外，还没有研究考虑过逆境如何聚集和复合 生命过程，在生态水平上相互作用，并促成最终导致艾滋病毒的共同因果链 感染拟议的项目将建立一个青少年群体，从出生起就进行跟踪， 马拉维家庭和健康纵向研究中父母提供的特殊现有数据 （劳动、社会保障和家庭部; 1998年成立）。我们建议直接从全球范围内收集两轮新的前瞻性数据。 MLSFH儿童进入青春期;在这样做时，我们将建立一个目前正在进入 艾滋病毒风险的关键年龄段，因为他们过渡到成年。目标是：目标1。来描述 青少年不良童年经历的患病率、共现率和复发率 在艾滋病流行的低收入国家。我们将构建从婴儿期开始的ACE指标 通过将1）通过先前MLSFH波中的父母报告捕获的丰富数据和2）新的 从青少年（11-15岁和14-18岁）中收集的数据，使用不良童年经历- 国际调查问卷（ACE-IQ）是世界卫生组织（WHO）最近开发的一项调查问卷。目标2.估计因果影响 ACE对青春期出现不同的艾滋病毒风险轨迹的影响。通过应用 通过复杂的统计方法，我们将能够研究早期和持续逆境的因果作用 关于艾滋病毒风险的出现，包括1）向成年的不良过渡2）行为风险和3）艾滋病毒和 HSV 2发病率。目标3。通过识别因果介导因素来突出潜在的干预点 ACE和HIV风险之间的关系我们专注于社交，情感和认知障碍，可能导致 频繁或慢性激活的压力反应，也可能有助于社会或行为艾滋病毒的风险。 目的4：确定保护因素，缓和ACE对HIV风险的影响。我们将测试潜力 多层次的复原力来源（例如，家庭资源，同伴支持，政府计划）， 确定儿童如何科普可以通过干预来加强。严格评估 儿童期逆境对青少年艾滋病毒风险的影响， 低收入国家目前的艾滋病毒预防战略，解释为什么一些青少年从事高风险活动， 通过确定可改变的干预目标，通过 将该项目整合到一项正在进行的纵向研究中，我们迅速创建了一个出生队列，促进了因果关系， 推断，确保及时的结果，并增加现有的，广泛使用的艾滋病毒研究资源的价值， 撒哈拉以南非洲的健康。