Suubi-Mhealth: A mobile health intervention to address depression and improve ART adherence among Youth living with HIV (YLHIV) in Uganda

Suubi-Mhealth：一种移动健康干预措施，旨在解决乌干达艾滋病毒感染者 (YLHIV) 青少年的抑郁症问题并提高抗逆转录病毒疗法的依从性

• 批准号: 10701072
• 负责人: Patricia A Cavazos-Rehg
• 金额: $ 17.13万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-08 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10701072
• 关键词: 15 year old; Address; Adherence; Adolescent; Adult; Africa South of the Sahara; Age; Behavior Therapy; Caregivers; Cellular Phone; Child; Clinic; Clinical; Cognitive Therapy; Control Groups; Depressed mood; Development; Drops; Evaluation; Evidence based intervention; Feedback; Focus Groups; Goals; HIV; HIV Infections; Health; Health Personnel; Intervention; Interview; Lead; Letters; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methodology; Methods; Mobile Health Application; Outcome; Persons; Phase; Practical Robust Implementation and Sustainability Model; Prevalence; Protocols documentation; Public Health; Quality of life; Research; Resource-limited setting; Risk; Sampling; Signal Transduction; Site; Specific qualifier value; Structure; Subgroup; Testing; Therapeutic Intervention; Time; Uganda; United States National Institutes of Health; Waiting Lists; Work; Youth; acceptability and feasibility; active method; antiretroviral therapy; behavioral health; comorbidity; depressive symptoms; digital treatment; evidence base; experience; health care settings; improved; innovation; intervention effect; intervention refinement; low and middle-income countries; mHealth; mobile application; pilot test; post intervention; primary outcome; programs; recruit; response; secondary outcome; social stigma; success; therapy adherence; tool; transmission process; treatment adherence; user centered design; young adult

PROJECT ABSTRACT Approximately 1.7 million children under 15 years old were living with HIV in 2020; and most new HIV infections (85%) occurred in Sub-Saharan Africa (SSA). People living with HIV (PLHIV) often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. However, 76% to 85% of PLHIV in SSA receive no treatment for serious mental health disorders, especially depression. Depression reduces ART adherence, which negatively impacts health and increases HIV transmission risks. Older adolescents (≥14 years) living with HIV are particularly vulnerable to these risks as caregivers withdraw or lessen their support during their transition to young adulthood. Moreover, older adolescents are also moving into larger and less accommodating adult HIV clinic settings and are at risk for dropping out of ART programs. Given that mental health services are severely under equipped in SSA, including in Uganda, and are inaccessible by many YLHIV, new solutions to increase access to mental health care and close the treatment gap are urgently needed. The overall goal of this proposed R21/33 study is to develop an mHealth intervention (Suubi-mhealth) for use among Ugandan youth (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. This digital therapy intervention delivered via a mobile application, will utilize the core tenets of cognitive-behavioral therapy (CBT) found to improve depression and ART adherence. The proposed study will specifically: Phase 1. R21 Aim 1: Develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand needs of youth living with HIV (YLHIV). We will conduct four focus groups with youth and two focus groups with health care providers (6-8 youth each) for feedback on intervention content and methods to increase participation and retention. R21 Aim 2: Based on results of Aim 1, explore the feasibility and acceptability subsequent refinement for the larger R33 phase. Phase of Suubi-Mhealth on a small scale (N=30), to inform 2. R33 Aim 1: Test the preliminary impact of Suubi- Mhealth versus a waitlist control group (N=200), on youth outcomes (depression, ART adherence, mental health functioning, quality of life, stigma). R33 Aim 2: Examine barriers and facilitators for integrating Suubi-Mhealth into health care settings for YLHIV. The study will be conducted in 10 health clinics in the greater Masaka region in Southern Uganda. We expect for Suubi-Mhealth to be an acceptable and feasible mHealth tool to reduce depression, improve ART adherence and overall mental health functioning among YLHIV. If the results of this pilot are promising, then the next step is an R01 to rigorously test Suubi-Mhealth in a larger trial, spanning multiple sites across Uganda.

项目摘要 到2020年，约有170万15岁以下儿童携带艾滋病毒；大多数新的艾滋病毒感染者 (85%)发生在撒哈拉以南非洲(SSA)。艾滋病毒携带者(PLHIV)经常与心理健康作斗争 降低其抗逆转录病毒治疗(ART)依从性的合并症。然而，在SSA中，76%到85%的PLHIV 没有接受严重精神健康障碍的治疗，尤其是抑郁症。抑郁降低了艺术 坚持，这会对健康造成负面影响，并增加艾滋病毒的传播风险。年龄较大的青少年(≥14岁) 艾滋病毒携带者特别容易受到这些风险的影响，因为照顾者在 他们向青壮年的过渡。此外，年龄较大的青少年也在向更大和更小的方向发展 适应成人艾滋病毒诊所的环境，并面临退出抗逆转录病毒治疗计划的风险。考虑到这种精神状态 在包括乌干达在内的南苏丹，卫生服务装备严重不足，许多青年艾滋病人无法获得卫生服务， 迫切需要新的解决办法，以增加获得精神卫生保健的机会，缩小治疗差距。这个 这项拟议的R21/33研究的总体目标是开发一种mHealth干预(Suubi-mHealth)，用于 患有艾滋病毒和抑郁症的乌干达青年(14-17岁)，考虑到他们独特的背景， 文化和发展需要。这种通过移动应用程序提供的数字治疗干预将 利用认知行为疗法(CBT)的核心原则来改善抑郁症和ART依从性。 拟议的研究将具体：阶段1。R21目标1：制定并反复改进干预措施 Suubi-mHealth议定书，以了解艾滋病毒携带者青年需求的形成工作为基础。我们 将举办四个有青年参加的重点小组和两个有保健提供者(各有6-8名青年)的重点小组 对干预内容和方法的反馈，以增加参与度和保留率。R21目标2：基于 目标1的结果，探索可行性和可接受性 随后对较大的R33阶段进行了细化。阶段 在小规模(N=30)开展Suubi-mHealth，以告知 2.R33目标1：测试Suubi的初步影响- MHealth与等待名单对照组(N=200)在青年结局(抑郁、对ART的坚持、精神健康)方面 功能、生活质量、耻辱)。R33目标2：检查整合Suubi-mHealth的障碍和促进者 进入YLHIV的卫生保健环境。这项研究将在大Masaka地区的10家医疗诊所进行 在乌干达南部。我们预计Suubi-mHealth将成为一种可接受和可行的mHealth工具，以减少 在青年艾滋病患者中，改善抗逆转录病毒治疗的依从性和整体心理健康功能。如果这件事的结果 试点是有希望的，那么下一步是R01，在一个更大的试验中严格测试Suubi-mHealth，跨越 乌干达各地的多个地点。