Growing Up: Intervening with HIV-Positive Adolescents in Resource-Poor Settings

成长：在资源匮乏的环境中对艾滋病毒阳性青少年进行干预

• 批准号: 9131811
• 负责人: JESSY G DEVIEUX
• 金额: $ 18.96万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-25 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9131811
• 关键词: 15 year old; 19 year old; AIDS prevention; AIDS/HIV problem; Adherence; Adolescence; Adolescent; Adult; Affect; Africa South of the Sahara; Anti-Retroviral Agents; Antiretroviral resistance; Back; Behavior; Behavior Therapy; Behavioral; CD4 Lymphocyte Count; Caregivers; Caribbean region; Caring; Child; Childhood; Chronic Disease; Clinic; Clinical; Cognitive; Cognitive Therapy; Communication; Country; Data; Development; Developmental Delay Disorders; Diagnosis; Disease; Distress; Economics; Education; Educational workshop; Elements; Epidemic; Evidence based intervention; Exposure to; Failure; Focus Groups; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; HIV-infected adolescents; Haiti; Haitian; Health; Health Care Costs; Health Personnel; Health Promotion; Incidence; Income; Inferior; Intervention; Interview; Joints; Learning; Life; Low income; Manuals; Measures; Methods; Modeling; Monitor; Moods; Morbidity - disease rate; Motivation; Outcome; Parents; Patients; Perinatal; Population; Prevalence; Preventive treatment; Procedures; Protocols documentation; Psychometrics; Psychosocial Assessment and Care; Psychosocial Factor; Randomized Controlled Trials; Recruitment Activity; Regimen; Reporting; Reproductive Health; Research; Resources; Risk; Risk Behaviors; Risk Reduction; Role; Services; Severities; Sex Behavior; Sexual Partners; Stress; Testing; Training; Translating; Treatment Cost; Treatment outcome; Unsafe Sex; Viral Load result; Work; Youth; antiretroviral therapy; arm; base; cohort; cost; evidence base; experience; improved; improved outcome; information model; innovation; low and middle-income countries; low income country; mortality; pediatric human immunodeficiency virus; pediatric human immunodeficiency virus infection; preference; primary caregiver; programs; psychological distress; response; scale up; skills; skills training; study population; therapy adherence; transmission process; treatment adherence; trial comparing

 DESCRIPTION (provided by applicant): As pediatric HIV infection has shifted from being a fatal disease to a chronic illness, a growing cohort of young people are moving through adolescence with all the challenges of the adult HIV-infected population but largely without comparable treatment outcomes or an evidence base to improve adherence to antiretroviral treatment (ART) and preventive behavior. Despite overall declines in HIV incidence and mortality since the ART scale-up, both have risen among youth. The goal of the proposed 3-year R34 developmental study is to respond to this need for tailored research, in particular among HIV+ older adolescents, and contribute to understanding the added value in resource-limited settings of including caregivers in an adherence and risk reduction program. Although caregiver involvement is a recognized correlate of outcomes in HIV+ youth, there are no rigorous studies of the role of caregivers in outcomes among HIV+ older adolescents. This project will integrate caregiver involvement and cognitive behavioral intervention (CBI) elements to improve ART adherence and HIV risk reduction for HIV+ older adolescents treated in resource-poor clinical settings. Our proposed study population will include caregivers and 15 to 19 year-old HIV+ youth who know their status and are receiving ART in Port-au-Prince, Haiti. Guided by the theoretical framework of the developmentally sensitive Information-Motivation-Behavioral Skills for Pediatric Adherence (IMB-PED), we will develop Growing Up (N'ap Grandi, in Haitian Creole) as a collaborative model of caregiver-adolescent engagement in the key informational, motivational, and behavioral skills antecedents of ART adherence and risk reduction. The proposed study partners with Haiti's largest youth health provider, FOSREF, and builds upon prior work with HIV+ youth and adults in Port-au-Prince. The study will utilize qualitative and quantitative methods to: identify barriers and facilitators to adherence and risk reduction (Aim 1); develop and pretest N'ap Grandi, including developmentally-appropriate manuals, training materials, procedures, and psychometric adequacy of measures (Aim 2); and assess feasibility and preliminary efficacy in a 3-arm randomized controlled trial (RCT), in which 120 youth will be assigned to three groups: the experimental caregiver-adolescent N'ap Grandi, an adolescent-only version (N'ap Grandi-A) and an adolescent-only health promotion group (HP-A), examining ART adherence and virologic response, HIV risk behaviors, positive communication and monitoring, stress and mood, and costs from the health center perspective (Aim 3). Isolation, inhibited communication, caregiver distress, adolescent ART non-adherence and HIV risk are very high in Haiti, which is a microcosm of the global pediatric HIV epidemic in low and middle income countries (LMICs) with generalized epidemics. After sub- Saharan Africa, the Caribbean is the most HIV-affected region in the world, with 50% of people with HIV infection living in Haiti. Our proposed study will be the first tailored intervention and RCT pilotd for HIV+ adolescents in Haiti, and will represent one of only a handful in LMICs globally.

 描述（由申请人提供）：随着儿科HIV感染从致命疾病转变为慢性疾病，越来越多的年轻人正在经历青春期，面临成年HIV感染人群的所有挑战，但在很大程度上没有可比的治疗结果或证据基础来改善抗逆转录病毒治疗（ART）和预防行为的依从性。尽管自抗逆转录病毒疗法推广以来，艾滋病毒发病率和死亡率总体下降，但在青年中，这两个数字都有所上升。拟议的3年R34发展研究的目标是响应这种定制研究的需求，特别是在HIV+老年青少年中，并有助于理解在资源有限的环境中将护理人员纳入依从性和风险降低计划的附加值。虽然照顾者的参与是一个公认的艾滋病毒阳性青年的结果的相关性，有没有严格的研究照顾者在艾滋病毒阳性的青少年的结果中的作用。该项目将整合照顾者参与和认知行为干预（CBI）的元素，以提高抗逆转录病毒治疗的依从性和降低艾滋病毒感染的风险，为艾滋病毒+老年青少年在资源匮乏的临床环境中治疗。我们建议的研究人群将包括护理人员和15至19岁的艾滋病毒阳性青年，他们知道自己的状况，并在海地太子港接受抗逆转录病毒治疗。由发展敏感的信息，动机，行为技能的儿科依从性（IMB-PED）的理论框架的指导下，我们将开发成长（N 'ap Grandi，在海地克里奥尔语）作为一个合作模式的青少年参与的关键信息，动机，和行为技能的前提下的ART依从性和降低风险。拟议的研究与海地最大的青年健康提供者FOSREF合作，并建立在太子港艾滋病毒阳性青年和成人的先前工作基础上。该研究将利用定性和定量方法：确定遵守和降低风险的障碍和促进因素（目标1）;制定和预先测试N 'ap Grandi，包括适合发展的手册、培训材料、程序和心理测量措施的适当性（目标2）;并在一项三臂随机对照试验（RCT）中评估可行性和初步疗效，其中120名青年将被分配到三组：实验性的青少年N 'ap Grandi，一个只接受艾滋病治疗的版本（N' ap Grandi-A）和一个只接受艾滋病治疗的健康促进组（HP-A），从健康中心的角度研究ART依从性和病毒学反应、HIV风险行为、积极的沟通和监测、压力和情绪以及成本（目标3）。孤立，抑制沟通，照顾者的痛苦，青少年抗逆转录病毒疗法的不遵守和艾滋病毒的风险非常高，在海地，这是一个缩影，全球儿科艾滋病毒流行病在低收入和中等收入国家（LMIC）的普遍流行。在撒哈拉以南非洲地区之后，加勒比地区是世界上受艾滋病毒影响最严重的地区，50%的艾滋病毒感染者生活在海地。我们提出的研究将是第一个针对海地艾滋病毒阳性青少年的量身定制的干预和随机对照试验，并将代表全球少数几个LMIC之一。