INTEGRATING A TRANSDIAGNOSTIC PSYCHOLOGICAL INTERVENTION IN THE CARE FOR ADOLESCENTS AND YOUTH WITH HIV IN KENYA

将跨诊断心理干预纳入肯尼亚艾滋病毒感染青少年的护理中

• 批准号: 10675988
• 负责人: Pamela Y Collins
• 金额: $ 52.8万
• 依托单位: UNIVERSITY OF NAIROBI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675988
• 关键词: AIDS prevention; Address; Adolescence; Adolescent; Adoption; Adult; Affect; Africa South of the Sahara; Age; Anxiety; Caring; Clinic; Clinic Visits; Clinical; Cluster randomized trial; Cognitive; Cognitive Therapy; Collaborations; Competence; Data; Development; Diagnostic; Disease Progression; Effectiveness; Elements; Frequencies; Funding; Future; Guidelines; HIV; HIV-infected adolescents; Health; Health Personnel; Health Services Accessibility; Health system; Hybrids; Improve Access; Income; Individual; International; Intervention; Kenya; Length; Low income; Maintenance; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Neuropsychology; Outcome; Patients; Persons; Pilot Projects; Policy Maker; Population; Problem Solving; Procedures; Process; Provider; Psychosocial Assessment and Care; Randomized, Controlled Trials; Recommendation; Relaxation; Research; Research Personnel; Schools; Services; Specialist; Stretching; Supervision; Symptoms; System; Telephone; Time; Training; Trauma; Treatment outcome; United States; Viral; Youth; antiretroviral therapy; anxiety symptoms; clinically significant; comorbidity; coping; cost; depressive symptoms; economic evaluation; effectiveness evaluation; effectiveness outcome; effectiveness testing; follow-up; high risk; implementation barriers; implementation context; implementation cost; implementation determinants; implementation intervention; implementation measures; implementation outcomes; implementation process; implementation/effectiveness; improved; innovation; low and middle-income countries; mental training; psychoeducation; psychoeducational; psychologic; psychological distress; psychological symptom; reduce symptoms; routine care; satisfaction; scale up; screening; secondary outcome; skills; standard of care; successful intervention; symptomatology; trauma symptom; uptake

Project Summary/Abstract Depression, anxiety, and trauma are common mental disorders that disproportionately affect adolescents and youth with HIV (AYHIV), and are associated with antiretroviral treatment (ART) non-adherence and poor treatment outcomes. The integration of mental health services in HIV care for AYHIV is recommended, but is lacking due to few trained mental health providers, and lack of a well validated integration models. Transdiagnostic interventions based on cognitive behavioral therapy (CBT) and delivered by lay health workers are effective in addressing these mental health conditions and could potentially improve HIV treatment outcomes. Barriers to integration of these interventions in the care of AYHIV in sub-Saharan Africa include paucity of effectiveness data among AYHIV and the lack of adaptation to tailor implementation for the HIV care context, including the length of treatment (number and frequency of sessions) and the format of delivery. This proposal builds on the successful pilot of Psychoeducation, Relaxation, PrOblem solving, Activation, Cognitive coping (PRO-ACT), a brief, modular and transdiagnostic intervention for adolescents and youth with mild to moderate symptoms of depression and anxiety in Kenya that resulted in clinically significant reduction in symptoms. The intervention can be delivered in stand-alone modules either in person or by phone, making it particularly appropriate for AYHIV when school is in session. In this project, we propose to further adapt PRO- ACT for the HIV care setting through a stakeholder engagement process with policymakers, mental health and adolescent HIV practitioners, and AYHIV. To prepare for the execution of trial, the stakeholders will identify and prioritize potential barriers to implementation and suggest adaptations to the implementation process that address key barriers. A pilot study at an HIV clinic with 10 providers and 20 AYHIV with mild to moderate symptoms will enable the study team to further adapt the intervention and study procedures. Using a hybrid 1 cluster randomized trial in 30 HIV clinics in Kenya, we will assess the effectiveness of PRO-ACT in reducing depressive, anxiety and trauma symptoms 6 months and 12 months after enrolment, comparing 300 AYHIV with mild to moderate symptoms in intervention to 300 in control clinics. To inform the integration of the intervention in routine care, we will measure implementation outcomes including reach, fidelity and maintenance, and explore multilevel determinants influencing reach, fidelity and maintenance in mental health screening and management, acceptability of training by providers and satisfaction with services by AYHIV. We will also conduct an economic evaluation through a time-driven activity- activities within the 30 clinics in participating in the study to estimate the implementation costs from a patient and health system perspective.

项目总结/摘要 抑郁、焦虑和创伤是常见的精神障碍，不成比例地影响青少年， 青年艾滋病毒感染者（AYHIV），并与抗逆转录病毒治疗（ART）的不依从性和贫困有关 治疗结果。建议将心理健康服务纳入对艾滋病毒携带者的艾滋病毒护理， 由于缺乏训练有素的心理健康提供者，以及缺乏经过充分验证的整合模式。 基于认知行为疗法（CBT）的跨诊断干预措施，由非专业卫生工作者提供 有效地解决这些心理健康问题，并可能改善艾滋病毒治疗结果。 在撒哈拉以南非洲，将这些干预措施纳入艾滋病毒/艾滋病护理的障碍包括缺乏 艾滋病毒/艾滋病感染者中的有效性数据，以及缺乏适应性以使实施工作适合艾滋病毒护理背景， 包括治疗的时间长短（疗程的次数和频率）和提供的形式。这项建议 建立在心理教育、放松、问题解决、激活、认知应对的成功试点基础上 （PRO-ACT），一个简短的，模块化和transdiagnosis干预青少年和青年轻度至 肯尼亚的中度抑郁和焦虑症状导致临床显著减少， 症状干预可以在独立模块中亲自或通过电话进行，使其 特别是在学校上课时，适合艾滋病毒携带者。在这个项目中，我们建议进一步调整PRO- 通过利益攸关方与政策制定者、心理健康和 青少年艾滋病从业人员和艾滋病病毒携带者。为准备执行审判，利益相关者将识别并 确定执行工作的潜在障碍的优先次序，并就执行进程的调整提出建议， 解决关键障碍。在一家艾滋病诊所进行的一项试点研究，有10名提供者和20名轻度至中度艾滋病病毒感染者 症状将使研究小组能够进一步调整干预和研究程序。使用Hybrid 1 在肯尼亚的30个艾滋病诊所进行的一项群集随机试验中，我们将评估PRO-ACT在减少 在入组后6个月和12个月，将300名AYHIV患者与 轻度至中度症状的干预，以300在控制诊所。告知干预措施的整合 在常规护理中，我们将衡量实施结果，包括覆盖率、忠诚度和维护率，并探索 影响心理健康筛查和管理中的覆盖范围、忠诚度和维护的多层次决定因素， 提供者对培训的接受程度以及艾滋病青年协会对服务的满意程度。我们还将进行经济 通过时间驱动的活动进行评价- 30家诊所参与研究，以估计患者和卫生系统的实施成本 perspective.