An interactive, narrative intervention to address the mental health treatment gap among young people living with HIV in Nigeria

一种互动式叙事干预措施，旨在解决尼日利亚艾滋病毒感染者年轻人的心理健康治疗差距

• 批准号: 10914342
• 负责人: Aimalohi Ahonkhai
• 金额: --
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-14 至 2023-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10914342
• 关键词: Address; Adherence; Adolescent; Adopted; Africa; Africa South of the Sahara; African; Appointment; COVID-19; Caregivers; Caring; Cause of Death; Cellular Phone; Climate; Clinic; Consolidated Framework for Implementation Research; Country; Development; Diagnosis; Disease remission; Distress; Effectiveness; Emotional; Epidemiology; Exploratory/Developmental Grant; Friends; Funding Opportunities; Future; General Population; Goals; HIV; Health; Health Professional; Health Promotion; Health Services Accessibility; Health Technology; Home; Individual; Interdisciplinary Study; Intervention; Knowledge; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Nigeria; Nonprofit Organizations; Outcome; Ownership; Patients; Persons; Play; Population; Provider; Psychiatric Social Work; Psychotherapy; Public Health; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Role; Side; Social Impacts; Technology; Testing; Therapeutic Intervention; Training; Treatment outcome; Universities; Visit; World Health Organization; Youth; acceptability and feasibility; age group; antiretroviral therapy; care providers; comorbidity; cost; design; digital; disorder control; effectiveness-implementation RCT; effectiveness/implementation hybrid; epidemic response; evidence base; experience; handheld mobile device; implementation barriers; implementation science; improved; innovation; interest; intervention delivery; low and middle-income countries; mHealth; medication compliance; mental training; multidisciplinary; novel; problem solving therapy; prototype; psychologic; psychological distress; satisfaction; screening; social cognitive theory; social stigma; stakeholder perspectives; telephone based; theories; usability; virtual environment

PROJECT SUMMARY Young people living with HIV (Y-PLWH) have poor adherence to antiretroviral therapy and engagement in HIV care, making HIV the leading cause of death for African adolescents. Depression and psychological distress are much more common among Y-PLWH than in the general population, and are associated with significantly worse adherence to care and treatment when compared to Y-PLWH without these co-morbid conditions. Thus, untreated depression and severe psychological distress are important contributors to poor HIV outcomes in this population. Nigeria is home to the 4th largest HIV population globally and 10% of Y-PLWH, but mental health screening is not routinely conducted in this setting, and less than 10% of those diagnosed have access to evidence-based care. Despite this treatment gap, few interventions have targeted the mental health needs of Y-PLWH in Africa. The World Health Organization recommends that caregivers of Y-PLWH adopt youth- friendly strategies and incorporate psychosocial services to meet their needs, and that task shifting to non- specialized health workers be used to overcome the dearth of trained professionals in low and middle-income countries. Task-shifted problem Solving Therapy (PST) has been effectively used by our team and others to treat both depression and psychological distress using a task-shifted approach. However, PST is an intensive strategy (typically 6-15 weekly sessions) often delivered in-person and poor completion rates are associated with less effectiveness -- a concern further magnified during the current COVID-19 climate. Mobile health technologies may be uniquely suited to surmount some of the obstacles for effective PST delivery in Nigeria and novel digital game-based strategies, can be utilized to promote engagement in mental health interventions on a platform that is compelling for young people. Our team has developed, a preliminary prototype of a theory-grounded game, Change My Story, in which players navigate difficult experiences based on drivers of psychological distress and interact with a virtual environment to choose a narrative path toward the story's conclusion. In this proposal, we will finalize the prototype of Change My Story, and integrate this game into a comprehensive, task-shifted PST intervention delivered via mobile phone to optimize engagement in mental health care. Through the R21 mechanism, we aim to: 1) finalize the Change My Story prototype to address key drivers of psychological distress among Y-PLWH in Nigeria and 2) establish the usability, feasibility, and acceptability of Change My Story among Y-PLWH with psychological distress in Nigeria. Through the R33 mechanism, we aim to 1) conduct a hybrid implementation-effectiveness pilot RCT for 80 Y-PLWH with depression or psychological distress, and compare feasibility, acceptability, engagement, satisfaction and preliminary effectiveness among individuals receiving PST alone or PST with Change My Story, and 2) use the Consolidated Framework for Implementation Research (CFIR) to assess factors influencing engagement, acceptability, and satisfaction along with facilitators and barriers to implementation delivery.

项目摘要 青年艾滋病毒感染者（Y-PLWH）坚持抗逆转录病毒治疗和参与艾滋病毒治疗的情况较差。 艾滋病毒是非洲青少年死亡的主要原因。抑郁和心理困扰 在Y-PLWH中比在一般人群中更常见，并且与显著相关。 与没有这些共病的Y-PLWH相比，对护理和治疗的依从性较差。 因此，未经治疗的抑郁症和严重的心理困扰是艾滋病毒结果不佳的重要因素 在这个人群中。尼日利亚是全球第四大艾滋病毒感染者和10%的Y-PLWH的家园，但精神 在这种情况下，健康检查不是常规的，只有不到10%的确诊者可以获得 以证据为基础的护理。尽管存在这种治疗差距，但很少有干预措施针对心理健康需求 非洲的Y-PLWH。世界卫生组织建议Y-PLWH的照顾者采用青少年- 友好的战略，并纳入心理社会服务，以满足他们的需要，并将任务转移到非 * 利用专业保健工作者克服中低收入国家缺乏训练有素的专业人员的问题; 国家任务转移问题解决疗法（PST）已被我们的团队和其他人有效地使用， 使用任务转移方法治疗抑郁症和心理困扰。然而，太平洋标准时间是一个密集的 战略（通常为每周6-15次会议）往往是亲自交付，与此相关的是完成率低 但效果不佳--在当前的COVID-19气候下，这一担忧进一步加剧。移动的健康 技术可能是唯一适合克服某些障碍，有效地在尼日利亚提供PST的技术 和新颖的基于数字游戏的策略，可用于促进参与心理健康干预 on a platform平台that is independent引人注目for young年轻people.我们的团队已经开发出了一种 一款以理论为基础的游戏，《改变我的故事》，玩家在游戏中根据不同的驱动因素， 心理困扰，并与虚拟环境互动，以选择故事的叙事路径 结论在这个提案中，我们将最终确定改变我的故事的原型，并将这个游戏整合到一个 通过移动的电话提供全面的任务转移PST干预，以优化心理参与 保健通过R21机制，我们的目标是：1）完成Change My Story原型，以解决关键问题 尼日利亚Y-PLWH中心理困扰的驱动因素，2）建立可用性，可行性， 尼日利亚有心理困扰的Y-PLWH对“改变我的故事”的可接受性。通过R33 我们的目的是：1）为80名青少年艾滋病毒携带者进行一项混合实施效果试验， 抑郁或心理困扰，并比较可行性，可接受性，参与度，满意度和 在单独接受PST或PST与Change My Story的个人中的初步效果，以及2）使用 实施研究综合框架（CFIR），以评估影响参与的因素， 可接受性和满意度沿着实施交付的促进因素和障碍。