SYV: A Mental Health Intervention to Improve HIV Outcomes in Tanzanian Youth

感染艾滋病毒的年轻人(10-24岁)是一个不断增长的人口，他们经历了独特的 精神健康方面的挑战，可能会危及他们的艾滋病毒护理。尽管有明显的需求，但很少有基于证据的 心理健康干预措施的存在是为了解决这一重要群体面临的困难。长期的 我们研究的目标是提供适合发展的、基于证据的心理健康干预措施 有效预防和治疗年轻人中的艾滋病毒，特别是在资源匮乏的情况下，那里的大多数人 流行病就会发生。Sauti ya Vijana(SYV，青年之声)，是一种新颖而创新的团体精神 与坦桑尼亚YPLWH一起设计并为坦桑尼亚YPLWH设计的健康和生活技能干预，以解决心理健康和生活问题 他们在我们之前的研究中描述了挑战。干预包括10个小组会议(两个联合 与照顾者)和两个单独的会议由受过训练的艾滋病毒携带者谁有 使用任务分担模式成功过渡到成人诊所，在克服困难的同时建设当地能力 在这种情况下，精神卫生专业人员的严重短缺。SYV合并了Trauma的组件 知情认知行为疗法、人际心理疗法和动机访谈 这一关键的神经发育时期，当自我和社会调节的基础实现时，可能会阻止 或者显著降低心理健康症状的严重程度。这项提案的总体目标是支持 积极的应对策略，以促进心理健康，并导致改善妇幼保健院的艾滋病毒结果。这个 中心假设是SYV将有效地改善抗逆转录病毒治疗(ART)的依从性和病毒学 坦桑尼亚青瓦台的镇压。这个项目的基本原理是，通过瞄准心理健康，这是 与服药依从性密切相关，我们将有效地提高依从性，从而改善艾滋病毒病毒 压制。中心假设将在混合类型1有效性实施中的三个目标中进行检验 审判。第一个目标将使用单独随机分组治疗试验设计来确定SYV是否有效 基于病毒学抑制(HIV RNA和400拷贝/毫升)增加10%的初步结果 YPLWH在干预组与标准护理组的比较。第二个目标将阐明这些机制。 通过评估潜在的主持人和调解人的SYV工作以及对谁是最有效的 采用结构方程模型进行干预。心理健康、内部污名、复原力和应对方式的变化 被假设为调节干预效果，而年龄、性别、地点和基线精神健康症状 是假想的主持人。最终目标将评价执行决定因素和成果，包括 执行研究综合框架指导下的成本效益和可持续性 (CFIR)以确定各站点之间的任何实施差异。这个项目意义重大，因为它预计 填补在低资源环境下照顾青见幼稚园方面的严重精神健康缺口，对 个人健康(抑制艾滋病毒)和人口健康(防止将艾滋病毒感染传染给他人)。

Young people living with HIV (YPLWH, 10-24 years of age) are a growing population that experience unique mental health challenges that may compromise their HIV care. Despite the clear need, few evidence-based mental health interventions exist to address the difficulties faced by this important population. The long-term goal of our research is to provide developmentally appropriate, evidence-based mental health interventions that effectively prevent and treat HIV in young people, especially in low resource settings where the majority of the epidemic occurs. Sauti ya Vijana (SYV, The Voice of Youth), is a novel and innovative group-based mental health and life skills intervention designed with and for Tanzanian YPLWH to address the mental health and life challenges they have described in our prior research. The intervention consists of 10 group sessions (two joint with caregivers) and two individual sessions delivered by trained young adults living with HIV who have successfully transitioned to the adult clinic using a task sharing model that builds local capacity while overcoming the critical shortage of mental health professionals in this setting. SYV incorporates components of Trauma Informed-Cognitive Behavioral Therapy, Interpersonal Psychotherapy, and Motivational Interviewing that during this critical neurodevelopmental period, when foundations of self and social regulation are realized, may prevent or dramatically reduce severity of mental health symptoms. The overall objectives of this proposal are to support positive coping strategies that bolster mental health and lead to improved HIV outcomes among YPLWH. The central hypothesis is that SYV will be effective to improve antiretroviral therapy (ART) adherence and virologic suppression in YPLWH in Tanzania. The rationale for this project is that by targeting mental health, which is strongly associated with medication adherence, we will effectively improve adherence and thereby HIV viral suppression. The central hypothesis will be tested in three aims in a hybrid type-1 effectiveness-implementation trial. The first aim will use an individually randomized group treatment trial design to determine if SYV is effective based on the primary outcome of 10% increase in virologic suppression (HIV RNA <400 copies/mL) among YPLWH in the intervention arm compared to standard of care. The second aim will elucidate the mechanisms by which SYV works and for whom it is most effective by evaluating potential moderators and mediators of the intervention using structure equation modelling. Change in mental health, internal stigma, resilience and coping are hypothesized to mediate the intervention effect, while age, sex, site, and baseline mental health symptoms are hypothesized moderators. The final aim will evaluate implementation determinants and outcomes, including cost effectiveness and sustainability guided by the Consolidated Framework for Implementation Research (CFIR) to identify any implementation differences among sites. This project is significant because it is expected to fill a critical mental health gap in caring for YPLWH in low resource settings with far-reaching implications on individual health (HIV suppression) and population health (preventing transmission of HIV infection to others).