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

描述(由申请人提供)：越来越多的围产期感染艾滋病毒(PHIV+)或暴露于艾滋病毒但未感染(PHIV-)的青年正在接近青年成年期，这个年龄越来越被认为是最具挑战性的过渡期之一，因为青年开始承担成年人的责任，并建立积极和危险的健康行为模式，延续到以后的生活。PHIV+年轻人在成长过程中感染了一种慢性性传播病毒，在治疗、性、人际关系和生育方面做出了关键选择。然而，文献中没有提到改善行为健康的策略，包括心理健康、性和药物使用的危险行为以及坚持抗逆转录病毒治疗(ART)，以及随着人口过渡到青年时期减少艾滋病毒向其他人的传播。这项建议是儿童和青少年自我意识与健康研究(NIMHR01-MH6913，CASAH 1和2)的竞争性延续，在该研究中，我们前瞻性地跟踪了较大的童年和青春期的PHIV+和PHIV-青年，收集了由我们的理论模型社会行动理论(SAT)提供信息的数据，这些数据关于个人、家庭、社会和行为健康的背景决定因素。在过去的4.5年里，CASAH发表了40篇科学报告，发表了63篇出版物(36篇手稿，27篇已发表的摘要)，提交了4篇手稿，并提供了支持5项NIH资助的干预研究的数据。这项竞争性的继续工作将扩展这项工作，以创建拟议的CASAH 3，从而形成12年来PHIV+和PHIV-青年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)艾滋病毒感染对青年时期行为健康(心理健康、性和药物使用风险行为)和转变的影响；2)来自SAT的早期发育阶段的关键风险和保护因素，以及风险和复原力框架如何影响年轻人的行为健康和转变；3)青春期行为健康的轨迹以及这些轨迹对年轻人转变的影响；以及4)(在PHIV+青年中)随着时间的推移对坚持艺术和医疗保健的影响。参与者最初是从纽约市的四个医疗中心招募的，年龄在9-16岁之间。在CASAH 1中，我们在相隔18个月的两个时间点收集青年及其照顾者的数据，而在CASAH 2中，我们在另外三个时间点(相隔一年)跟踪年轻人进入老年青春期。在CASAH 3中，18-26岁的年轻人将被重新招募，并在三次年度访问中接受面试。此外，还将利用多项遵守指标， 包括每月未公布的电话药片计数、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PHIV+青少年的心理健康和艾滋病毒预防干预和服务系统提供信息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，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子，以及艾滋病毒的作用，这对亟需的干预发展至关重要。

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.