Risk and Resilience Trajectories to Young Adulthood: The Role of Perinatal HIV

描述（由申请人提供）：越来越多的围产期艾滋病毒感染（PHIV+）或艾滋病毒暴露，但未感染（PHIV-）的青年正在接近青年成年，这个年龄越来越被认为是最具挑战性的过渡时期之一，因为青年开始承担成人的责任，并建立积极和危险的健康行为模式，并持续到以后的生活。PHIV阳性的年轻人正在对治疗、性、关系和生育做出关键的选择，他们在慢性性传播病毒的环境中长大。然而，文献是沉默的战略，以改善行为健康，包括心理健康，性和物质使用的风险行为和坚持抗逆转录病毒治疗（ART），以及减少艾滋病毒传播给他人，因为这一人群过渡到年轻的成年。该提案是儿童和青少年自我意识和健康研究（NIMHR 01-MH 6913，CASAH 1和2）的竞争性延续，在该研究中，我们前瞻性地跟踪了PHIV+和PHIV-青少年的童年和青春期，收集了我们的理论模型，社会行动理论（SAT）关于个人，家庭，社会和行为健康的背景决定因素的数据。在过去的4.5年中，CASAH已经产生了40个科学报告，63篇出版物（36篇手稿; 27篇已发表的摘要），4篇提交的手稿，以及支持5项NIH资助的干预研究的数据。这种竞争性的继续将扩展这项工作，以创建拟议的CASAH 3，从而在12年的PHIV+和PHIV-青年的行为健康的心理社会决定因素的概况。在CASAH 3中，我们将研究1）HIV感染对行为健康的影响（心理健康，性和物质使用风险行为）和青年成年期的过渡; 2）来自早期发展阶段的关键风险和保护因素，来自SAT，以及风险和弹性框架如何影响青年成年人的行为健康和过渡; 3）整个青春期的行为健康轨迹以及这些轨迹对年轻成年人过渡的影响;以及4）（在PHIV+青年中）随着时间的推移对坚持ART和医疗保健的影响。参与者最初从纽约市的四个医疗中心招募，年龄在9-16岁之间。在CASAH 1中，我们在两个时间点收集了关于青少年及其照顾者的数据，间隔18个月，在CASAH 2中，我们在另外三个时间点跟踪了青少年进入青春期，间隔一年。在CASAH 3中，将重新招募18-26岁的年轻人，并在三次年度访问中进行访谈。此外，还将利用多种遵守情况指标， 包括每月的、未公布的基于电话的药丸计数、自我报告和医疗记录数据。CASAH是为数不多的直接为美国和全球范围内的PHIV+青少年提供心理健康和HIV预防干预措施和服务系统的决定因素研究之一。CASAH-3提供了一个时间敏感和独特的机会，可以检查从儿童到青年的扩展行为健康轨迹，这些轨迹和青年过渡的理论上知情和可修改的预测因素，以及艾滋病毒的作用，这对急需的干预措施至关重要。

DESCRIPTION (provided by applicant): Growing numbers of perinatally HIV-infected (PHIV+) or HIV-exposed, but uninfected (PHIV-) youth are approaching young adulthood, an age increasingly recognized as one of the most challenging transition periods as youth begin to assume adult responsibilities and establish patterns of positive and risky health behaviors that carry through to later life. PHIV+ young adults are making critical choices about treatment, sex, relationships, and child-bearing having grown up with a chronic sexually transmittable virus. Yet, the literature is silent about strategies to improve behavioral health, including mental health, sexual and substance use risk behavior and adherence to antiretroviral treatment (ART), as well as reduce HIV transmission to others as this population transitions into young adulthood. This proposal is a competing continuation of Child and Adolescent Self-awareness and Health study (NIMHR01-MH6913, CASAH 1 and 2), in which we have prospectively followed PHIV+ and PHIV- youth across older childhood and adolescence, collecting data informed by our theoretical model, Social Action Theory (SAT) on individual, family, social, and contextual determinants of behavioral health. In the past 4.5 years, CASAH has resulted in 40 scientific presentations, 63 publications (36 manuscripts; 27 published abstracts), 4 manuscripts in submission, and data that supported 5 NIH-funded intervention studies. This competing continuation will extend this work to create the proposed, CASAH 3, resulting in a 12-year profile of the psychosocial determinants of behavioral health in PHIV+ and PHIV- youth. In CASAH 3, we will examine 1) the impact of HIV infection on behavioral health (mental health, sexual and substance use risk behavior) and transitions in young adulthood; 2) how critical risk and protective factors from earlier developmental stages, drawn from SAT, as well as a risk and resilience framework affect young adult behavioral health and transitions; 3) trajectories of behavioral health across adolescence and the influence of these trajectories on young adult transitions; and 4) (among PHIV+ youth) influences on adherence to ART and health care over time. Participants were originally recruited at ages 9-16 years from four medical centers in NYC. In CASAH 1, we collected data on youth and their caregivers at two time points, 18 months apart, and in CASAH 2, we followed the youth into older adolescence at three additional time points, one year apart. In CASAH 3, young adults, ages 18-26 years, will be re-recruited and interviewed at three annual visits. In addition, multiple indicators of adherence will be utilized, including monthly, unannounced phone-based pill counts, self-reports, and medical record data. CASAH is one of the few determinants studies that has directly informed mental-health and HIV-prevention interventions and service systems for PHIV+ adolescents in the US and global contexts. CASAH-3 offers a time-sensitive and unique opportunity to examine extended behavioral health trajectories from childhood to young adulthood, theoretically informed and modifiable predictors of these trajectories and young adult transitions, and the role of HIV, critical to much needed intervention development.