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期，这一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，这些行为将延续到以后的生活。感染艾滋病毒的年轻人在治疗、性、人际关系和生育方面做出了关键的选择，他们从小就感染了慢性性传播病毒。然而，文献对改善行为健康的策略保持沉默，包括心理健康、性和物质使用风险行为、坚持抗逆转录病毒治疗（ART），以及随着这一人群过渡到青年期，减少艾滋病毒传播给他人。该建议是儿童和青少年自我意识与健康研究（NIMHR01-MH6913， CASAH 1和2）的竞争延续，在该研究中，我们前瞻性地跟踪了童年和青少年时期的PHIV+和PHIV-青年，收集了我们的理论模型——社会行动理论（SAT）关于个人、家庭、社会和环境决定因素的数据。在过去的4年半里，CASAH发表了40篇科学报告，63篇出版物（36篇手稿，27篇已发表摘要），4篇正在提交的手稿，以及支持5项nih资助的干预研究的数据。这一竞争性的延续将扩展这项工作，以创建拟议的CASAH 3，从而对PHIV+和PHIV-青年行为健康的社会心理决定因素进行为期12年的分析。在CASAH 3中，我们将检查1)艾滋病毒感染对行为健康的影响（心理健康，性和物质使用风险行为）和青年期的过渡；2)来自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)青少年期行为健康轨迹及其对青年转变的影响；4)随着时间的推移（在艾滋病毒阳性青年中）对坚持抗逆转录病毒治疗和卫生保健的影响。参与者最初从纽约市的四个医疗中心招募了9-16岁的参与者。在CASAH 1中，我们在两个时间点（间隔18个月）收集青少年及其照顾者的数据，在CASAH 2中，我们在另外三个时间点（间隔一年）跟踪青少年进入青春期。在CASAH 3中，年龄在18-26岁的年轻人将被重新招募，并在三次年度访问中接受采访。此外，将使用多种依从性指标，

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.