Exploring the mental health and wellbeing of adolescent parent families affected by HIV in South Africa

非洲的青少年人口（10-19岁;世卫组织，2017年）是世界上增长最快的，预计到2050年将达到4.35亿（联合国，2019年）。因此，青少年的健康-心理健康是青少年健康的一个基本组成部分-对于促进个人潜力、确保本区域和子孙后代的繁荣变得越来越重要。青春期心理健康状况不佳对个人和更广泛的社会产生广泛的负面影响（联合国人口基金，2014年）。然而，儿童和青少年的心理健康仍然是一个被忽视的全球卫生优先事项。青少年怀孕和感染艾滋病毒都与心理健康状况不佳有关（Vreeman，2017; Dahmen，2019）。然而，当这两种现象同时发生时，探索心理健康的文献（除了候选人的论文）很少。感染艾滋病毒和受艾滋病毒影响的青少年及其子女是撒哈拉以南非洲地区未来繁荣和艾滋病毒防治工作的核心人口。然而，青少年父母家庭感染艾滋病毒和受艾滋病毒影响的研究仍然不足，因此在干预和预防方面服务不足。HEY BABY研究是对居住在南非东开普省的1000多名青少年母亲（感染和未感染艾滋病毒）及其子女的队列研究。研究中收集了四个部分的数据：（i）健康和福祉问卷（包括经验证的心理健康措施），（ii）育儿问卷（详细介绍育儿经验），（iii）对儿童认知发展的直接评估，以及（iv）儿童健康记录。对这些数据的横截面分析（由候选人承担）强调，在撒哈拉以南非洲地区，与未感染艾滋病毒的母亲相比，感染艾滋病毒的少女母亲的心理健康状况更差，与成年母亲相比，少女母亲所生子女的儿童发育评分更低，与未感染艾滋病毒的儿童相比，感染艾滋病毒的儿童和感染艾滋病毒的未感染儿童的发育得分较低。这些分析还确定了母亲创伤后应激与儿童认知发展评分较低以及父亲在照顾子女方面的参与度较低（<20%）之间的关联。暴力暴露和缺乏社会支持被认为是样本中青少年母亲心理健康状况不佳的相关因素，但需要进行纵向分析，以进一步了解这些发现。拟议的研究金旨在使候选人能够：1。巩固候选人博士学位内的作品，并将这些作品扩展到包括纵向随访数据。这些工作将侧重于确定可纳入政策和方案的可行因素，以改善受艾滋病毒影响的青少年父母（母亲和父亲）的心理健康及其子女的发展。这些工作也将有助于更好地理解未成年母亲所生子女的父亲的经历（这是一个经常被忽视的群体）2。编写分析报告和手稿，供出版和传播。参加会议和利益相关者会议，以实现知识转移和建立网络4.为未来可能的合作奠定基础，重点关注撒哈拉以南非洲和高收入国家青少年父母家庭的心理健康，目的是扩大论文和博士后活动结果的应用。接受进一步培训，以建立与方法有关的技能，并在学术界建立职业生涯6。开发资金申请，以推进作为博士后研究金一部分的工作，并进一步解决数据需求，以便有效制定有意义的政策和方案，为今世后代服务

Africa's adolescent population (10-19 years; WHO,2017) are the fastest growing the in world - projected to reach 435 million by 2050 (United Nations,2019). Consequently, the health of adolescents, of which mental health is a fundamental component, is becoming increasingly important to promote individual potential, and ensure the prosperity of the region, and future generations. Poor mental health within adolescence has broad negative implications for individuals and wider society (United Nations Population Fund,2014). Yet, the mental health of children and adolescents remains an overlooked global health priority. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with poor mental health (Vreeman,2017; Dahmen,2019). However, there is a dearth of literature (beyond the candidate's thesis) exploring mental health when both phenomena co-occur. Adolescents and their children living with and affected by HIV are a core population in both the future prosperity of the sub-Saharan Africa region and the HIV response. However, adolescent parent families living with and affected by HIV remain understudied, and thus underserved with regard to intervention and prevention.The HEY BABY study is a cohort study of over 1000 adolescent mothers (both living with and not living with HIV) and their children residing in the Eastern Cape province, South Africa. Four components of data are collected within the study: (i) a health and wellbeing questionnaire (including validated mental health measures), (ii) a parenting questionnaire (giving detail on parenting experience), (iii) a direct assessment of child cognitive development, and (iv) child health records. Cross-sectional analyses of these data (undertaken by the candidate) have highlighted elevated poor mental health among adolescent mothers living with HIV compared to mothers not living with HIV, lower child development scores among children born to adolescent mothers compared to adult mothers within the sub-Saharan African region, and lower developmental scores among children living with HIV and HIV exposed uninfected children compared to children unexposed to HIV. These analyses have also identified an association between maternal posttraumatic stress and lower child cognitive development scores, and low paternal engagement within the care of their children (<20%). Violence exposure and lack of social support were found to be correlates of poor mental health among adolescent mothers in the sample, however longitudinal analyses is required to further understand such findings. The proposed fellowships aims to allow the candidate to: 1. Consolidate the works within the candidate's PhD and extending these works to include longitudinal follow-up data. These works will focus on identifying amenable factors that could be integrating into policy and programming to improve the mental health of adolescent parents (both mothers and fathers) affected by HIV, and the development of their children. These works will also on developing a greater understanding the experience of fathers of children born to adolescent mothers (an often-overlooked group)2. Develop analyses and manuscripts for publication and dissemination 3. Attend conferences, and stakeholder meetings to allow for knowledge transition and networking 4. Develop the foundations for future possible collaborations focusing on the mental health of adolescent parent families from both sub-Saharan Africa and high-income countries with the aim of extend the application of findings from both the thesis and postdoctoral activities5. Undertake further training to build skills relating to methodology, and to establish a career in academia 6. Develop funding applications to advance the works undertaken as part of this postdoctoral fellowship, and to further address the need for data to allow for the effective development of meaningful policy and programming to serve current and future generations