Integrating Mental Health into a HIV Clinic to Improve Outcomes in Tanzanian Youth

描述(由申请人提供)：Dorothy Dow博士拥有全球卫生理学硕士学位，将于2014年7月成为杜克大学医学中心儿科传染病系的初级教员。近三年来，她一直在坦桑尼亚的莫什生活和工作。她的长期目标是成为一名独立的全球卫生研究人员，将心理健康纳入青少年艾滋病毒的预防和治疗。在杜克大学和乞力马扎罗基督教医学中心(KCMC)进行艾滋病毒诊所期间，陶氏博士认识到了这句话的现实：“没有心理健康就没有健康。”她的初步研究评估了坦桑尼亚艾滋病毒阳性青少年中精神健康问题的流行情况，表明抑郁和创伤症状在当地艾滋病毒青年诊所很普遍。尽管有这些发现，KCMC目前还没有心理学家或精神病学家。这项拟议的职业发展计划包括一个多学科的五年计划，其中包括全球心理健康、研究方法和试验设计、高级生物统计学以及实施大型临床试验的管理技能方面的教学培训。这些授课方法与指导下的、以病人为中心的 在HIV青少年诊所设计、调整和实施心理健康干预的研究经验。Dow博士将接受科林·坎宁安博士(儿科传染病和儿科全球卫生首席)、Karen O‘Donnell博士(临床心理学)、Kathryn Whetten博士(卫生政策和不平等研究中心主任)、Blandina Mmbaga博士(共同网站负责人、KCMC-Duke Collaboration儿科教授)以及顾问John Bartlett博士(杜克全球卫生研究所，DGHI)和Kathen Sikkema博士(临床心理学)的指导。Dow博士建议将HIV教育课程和名为SPARCS的强化认知行为疗法(CBT)和生活技能培训计划整合到HIV青少年诊所。第一个目标是创建一个工具包，使艾滋病毒教育课程和SPARCS与文化相关，并使用斯瓦希里语。第二个目标是一项可行性研究，以确定SPARCS是否可以改善精神健康、依从性和病毒结果。根据Dow博士的导师成功地在坦桑尼亚的孤儿中实施以创伤为重点的CBT的工作，预计在资源有限的情况下实施SPARCS也是可行的。这个假设是，通过解决心理健康需求，年轻人将表现出更好的抗逆转录病毒治疗依从性和改善的病毒学结果。该项目预计将改善坦桑尼亚艾滋病毒阳性青少年的心理和身体健康，并在这一背景下开启关于心理健康困难的讨论对话。在完成这项可行性研究以及进一步的教学和指导后，候选人计划提交一份R01赠款，作为随机对照试验评估这一干预措施的效果，实现她的目标，即开展独立的全球健康研究，以改善生活在坦桑尼亚和其他资源有限环境中的青少年的整体健康。

DESCRIPTION (provided by applicant): Dr. Dorothy Dow has a Master's of Science in Global Health and will become junior faculty at Duke University Medical Center in the Division of Pediatric Infectious Diseases in July 2014. For nearly three years, she has been living and working in Moshi, Tanzania. Her long-term goal is to become an independent global health researcher integrating mental health into the prevention and treatment of HIV among adolescents. During HIV clinic both at Duke University and Kilimanjaro Christian Medical Centre (KCMC), Dr. Dow has come to realize the reality of the statement, "no health without mental health." Her preliminary research evaluating the prevalence of mental health difficulties among HIV-positive adolescents in Tanzania has demonstrated symptoms of depression and trauma are prevalent in the local HIV youth clinic. Despite these findings, there are no psychologists or psychiatrists currently available at KCMC. This proposed career development plan incorporates a multidisciplinary five-year program complete with didactic training in global mental health, research methods and trial design, advanced biostatistics, and management skills for implementing large clinical trials. These didactics closely align with a mentored, patient-oriented research experience designing, adapting, and implementing a mental health intervention in the HIV adolescent clinic. Dr. Dow will receive mentorship from Dr. Coleen Cunningham (Chief, Pediatric Infectious Diseases and Pediatric Global Health), Dr. Karen O'Donnell (Clinical Psychology), Dr. Kathryn Whetten (Director of the Center for Health Policy and Inequalities Research), Dr. Blandina Mmbaga (Co-Site leader KCMC-Duke Collaboration, Professor of Pediatrics), and consultants Dr. John Bartlett (Duke Global Health Institute, DGHI) and Dr. Kathleen Sikkema (Clinical Psychology). Dr. Dow proposes to integrate both a HIV educational curriculum and an intensive cognitive behavioral therapy (CBT) and life skills training program called SPARCS, into the HIV teen clinic. The first aim is to create a tool kit by adapting both a HIV educational curriculum and SPARCS to be culturally relevant and in Swahili language. The second aim is a feasibility study to determine if SPARCS improves mental health, adherence, and viral outcomes. Based on the work of Dr. Dow's mentors who have successfully implemented trauma-focused CBT among orphans in Tanzania, it is anticipated that SPARCS will also be feasible to implement in a resource-limited setting. The hypothesis is that by addressing mental health needs, youth will demonstrate improved ART adherence and improved virologic outcomes. This project is anticipated to improve both mental and physical health of HIV-positive adolescents in Tanzania and open a dialogue of discussion around mental health difficulties in this setting. Upon completion of this feasibility study and further didactics and mentorship, the candidate plans to submit a R01 grant to evaluate the efficacy of this intervention as a randomized controlled trial, fulfilling her goal of conducting independent global health research to improve the overall health of adolescents living in Tanzania and other resource-limited settings.