Intergenerational Intervention: Employing Youth to Promote Aging Healthy with HIV in Rural South Africa

项目总结： 南非快速增长的老年艾滋病毒携带者人数(OPLHV)与艾滋病毒相关的结果并不理想，因为他们面临着残疾和慢性病水平的上升，以及缺乏明确针对老年人口的艾滋病毒护理和治疗干预措施。由于几乎没有其他以家庭为基础的护理方式，大多数老年非洲人都在适当地老龄化，但随着中产阶层被掏空，劳动力迁移率很高，需要将目光投向其他地方，寻求健康老龄化所需的多方面支持。拟议的项目旨在探讨创新的代际干预措施如何改进艾滋病毒和相关共病的管理办法，同时通过雇用青年在其社区协助艾滋病毒感染者，为南非的年轻一代提供机会，因为在南非，青年失业是一个国家关切的问题。为了形成早期干预发展，拟议的形成性和序贯混合方法研究的目的是：1)通过对NIH资助的研究--非洲的健康和老龄化：INDEPTH社区的纵向研究--的现有量化数据的纵向分析，确定社会支持的决定因素--包括抗逆转录病毒治疗、多病并存的管理和生活满意度--以及这种支持如何受到家庭结构和构成的调节；以及2)阐明如何从战略上代际填补社会支持缺口，并为可行的干预措施提供信息。将利用定性数据与主要干预利益攸关方一起实现这一目标，其中包括：a)对老年人及其家庭成员(S)进行深入访谈；b)对来自社区的主要信息提供人进行半结构化访谈；以及c)与青年进行焦点小组讨论。这一项目是为了应对日益增长的成年艾滋病毒携带者及相关并存人口的需要，同时增加证据基础，以支持在不同环境和不同亚群中设计预防艾滋病的干预措施。

PROJECT SUMMARY: South Africa’s rapidly growing population of older adults living with HIV (OPLHV) have suboptimal HIV-related outcomes, as they face a concomitant rise in levels of disability and chronic disease on top of a lack of HIV care and treatment interventions explicitly targeting older populations. With few alternatives to family-based care, most older Africans age in place, but with the “hollowed out” middle generation and high rates of labor migration, there is need to look elsewhere to seek the multi-dimensional support needed to age healthily. The proposed project aims to explore how an innovative intergenerational intervention could improve approaches to the management of HIV and related co-morbidities among OPLHV while offering opportunity to the younger generation in South Africa, where youth unemployment is a national concern, by employing youth to assist OPLHV in their communities. To shape early intervention development, the proposed formative and sequential mixed methods study aims to: 1) Identify the determinants of social support associated with aging healthy with HIV by gender and across the later life course—including ART management, management of multimorbidities, and life satisfaction—and how that support is moderated by household structure and composition, through longitudinal analysis of existing quantitative data from the NIH-funded study, Health and Aging in Africa: Longitudinal Studies of an INDEPTH Community; and 2) Elucidate how social support gaps can be strategically filled intergenerationally and inform a feasible intervention. This aim will be met using qualitative data with key intervention stakeholders, including a) in-depth interviews with older adults and their household member(s); b) semi-structured interviews with key informants from the community; and c) focus group discussions with youth. This project responds to the need to prepare for the growing population of adults aging with HIV and related co-morbidities while increasing the evidence base to support the design of interventions for OPLHV in diverse settings and subpopulations.