Shaping the Health of Adolescents in Zimbabwe (SHAZ!)

塑造津巴布韦青少年的健康（SHAZ！）

• 批准号: 7878181
• 负责人: Megan Suzanne Dunbar
• 金额: $ 50万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-16 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7878181
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Behavior; Behavior Therapy; Behavioral; Body mass index; CD4 Lymphocyte Count; Caring; Child; Clinic; Clinic Visits; Clinical; Communities; Confidentiality; Coping Skills; Cost Savings; Counseling; Disclosure; Economic Factors; Economics; Education; Ensure; Epidemic; Equipment; Ethics; Feasibility Studies; Female; Female Adolescents; Foundations; Funding; Future; Grant; HIV; HIV Seropositivity; Health; Health Services Accessibility; Hospitals; Incidence; Income; Information Resources; International; Intervention; Knowledge; Life; Link; Measures; Mediating; Mediation; Modeling; Morbidity - disease rate; Motivation; Opportunistic Infections; Orphan; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Plague; Policies; Population; Population Study; Pregnancy Rate; Preventive Intervention; Psychosocial Factor; Randomized; Randomized Controlled Trials; Reporting; Research; Research Infrastructure; Resources; Risk; Risk Behaviors; Savings; Schools; Secondary Prevention; Sexually Transmitted Diseases; Shapes; Social support; Stigmata; Stress; Training; Treatment outcome; Universities; Unsafe Sex; Vulnerable Populations; Weight; Woman; Work; Zimbabwe; abstracting; antiretroviral therapy; base; clinical care; cohort; conditioning; coping; depression; design; empowered; food security; girls; high risk sexual behavior; improved; innovation; male; meetings; policy implication; programs; prophylactic; psychologic; psychosocial; safer sex; sex; sex risk; skills; social; social stigma; tool; transmission process; uptake

PROJECT SUMMARY/ABSTRACT Zimbabwe is confronting the synergistic plagues of a generalized HIV epidemic and rapid economic decline. Both have contributed to the large number of orphans and vulnerable children (OVC) estimated at 1.5 million in 2007. Adolescent female OVC have limited access to educational and economic opportunities, are twice as likely to be HIV infected than their male counterparts, and are more likely than non-OVC to engage in high-risk sexual behavior. Among those that are HIV infected, economic vulnerability and the psychological consequences of being poor and HIV positive, increase the risk of secondary transmission and poor access to care. There is a clear need to address secondary prevention (of HIV transmission and of HIV- related psychological morbidity) in this vulnerable population; however, existing behavioral interventions are likely to have limited impact in that they do not address the fundamental economic factors conditioning behavior. It is critical that structural interventions that do address such factors be developed and evaluated. Through this continuation proposal, we propose to expand SHAZ! (Shaping the Health of Adolescents in Zimbabwe)-an HIV prevention intervention that empowers adolescent female OVC to avoid sexual risk behaviors by improving economic opportunities and linking them to life skills-based HIV education and clinical care-to HIV-positive participants. Building on pilot work among 20 HIV-positive participants integrated into the SHAZ! study, here we propose to conduct a full study of "SHAZ! for Positives" among 650 additional HIV-positive participants, all of whom will be linked to clinical care and then randomly assigned to the combined economic (vocational training, guidance counseling, and a micro-grant) and life skills intervention compared to the life skills intervention alone. Initiating this expansion while the main study is ongoing (targeted for completion in early 2009) will enable us to build on our existing infrastructure and, thus, effect substantial cost savings, as well as conceal the HIV status of study participants, facilitating our ethical mandate to ensure confidentiality. Through our proposed design-that brings together the Women's Global Health Imperative at RTI International, the University of Zimbabwe-UCSF Research Programme, the Pangaea Global AIDS Foundation and the HIV/AIDS clinic at the Chitungwiza Hosptial-we will evaluate the effect of SHAZ! for Positives on: (1) indicators of economic livelihoods and social resources; (2) adherence to care and treatment, and subsequent health outcomes; (3) psychosocial morbidity, disclosure, and coping skills; (4) behaviors associated with the secondary transmission of HIV, and (4.a) whether secondary transmission risk behavior is mediated by treatment outcomes or psychosocial factors. If this innovative SHAZ! for Positives model is proven effective, these findings will have far-reaching program and policy implications in the region and beyond.

项目摘要/摘要 津巴布韦正面临着普遍的艾滋病毒流行和快速的经济增长的协同作用 拒绝。两者都是造成大量孤儿和弱势儿童(OVC)的原因，估计 2007年为150万人。青春期女性OVC获得教育和经济机会有限， 感染艾滋病毒的可能性是男性的两倍，而且比非卵巢癌患者更有可能感染艾滋病毒 从事高风险的性行为。在那些感染艾滋病毒的人中，经济脆弱性和 贫穷和艾滋病毒阳性的心理后果，增加了二次传播和 获得医疗服务的机会很少。显然需要解决二级预防(艾滋病毒传播和艾滋病毒-- 相关心理障碍)；然而，现有的行为干预措施是 可能产生的影响有限，因为它们没有解决基本的经济因素制约 行为。制定和评估针对这些因素的结构性干预措施至关重要。 通过这一延续提议，我们提议扩大Shaz！(塑造中国青少年的健康 津巴布韦)-一项艾滋病毒预防干预措施，使青少年女性OVC能够避免性风险 通过改善经济机会并将其与以生活技能为基础的艾滋病毒教育和 临床护理--针对艾滋病毒阳性参与者。以20名艾滋病毒阳性参与者的试点工作为基础 融入了沙士！研究，在这里，我们建议对650个积极词进行一次全面的研究 其他艾滋病毒阳性参与者，所有人都将被联系到临床护理，然后随机分配到 经济(职业培训、指导咨询和小额补助)和生活技能相结合 干预与单独的生活技能干预相比。在主要研究是 正在进行的(计划于2009年初完成)将使我们能够在现有基础设施的基础上进行建设，因此， 节省大量成本，并隐瞒研究参与者的艾滋病毒状况，促进我们的道德 确保保密性的任务。通过我们提议的设计-将女性全球 国际RTI的健康需求，津巴布韦大学-加州大学旧金山分校研究方案， 泛古全球艾滋病基金会和Chitungwiza医院的艾滋病毒/艾滋病诊所-我们将评估 沙兹的效果！关于以下方面的积极因素：(1)经济生计和社会资源指标；(2)坚持 护理和治疗以及随后的健康结果；(3)心理社会发病率、披露和应对 技能；(4)与艾滋病毒二次传播有关的行为；以及(4)是否为二次传播 传播危险行为受治疗结果或心理社会因素的影响。 如果这个创新的沙兹！对于实证模型被证明是有效的，这些发现将具有深远的意义 计划和政策在该地区和其他地区的影响。