E Kinyanda, MRC/UVRI Uganda Research Unit on AIDS - Mental health among HIV infected CHildren and Adolescents in KAmpala, Uganda (CHAKA)

艾滋病毒对撒哈拉以南非洲的儿童和青少年的影响不成比例，90%的感染者居住在那里。乌干达是该地区感染率第五高的国家，在120万艾滋病毒携带者中，超过10%的人年龄在15岁以下。除了身体上的影响，感染艾滋病毒的儿童和青少年(CA-HIV)报告精神健康状况不佳。来自高收入国家的流行病学研究发现，精神障碍(PD；例如抑郁、焦虑和行为障碍)的发生率很高。关于CA-HIV中帕金森病危险因素的证据仍然没有定论。然而，潜在的风险因素包括：产妇健康状况不佳；艾滋病毒疾病严重程度；照料者帕金森病；艾滋病毒相关的神经/发育障碍；耻辱、家庭死亡和负面环境因素；疼痛；以及遗传因素。尽管撒哈拉以南非洲承担着青年艾滋病毒的最大负担，但几乎没有开展研究来更好地了解该地区CA-HIV患者的精神问题。这项研究的目的是调查帕金森病对乌干达CA-HIV的影响以及对服务提供的影响。这项研究的目的是：(1)确定CA-HIV中帕金森病(包括神经认知障碍)的患病率、12个月的发病率和预测因素；(2)调查5-羟色胺转运体基因差异与抑郁障碍之间的关系；(3)研究帕金森病对艾滋病毒疾病进展的影响；(4)检查帕金森病对社会和学术功能以及危险行为(如坚持治疗、饮酒、性行为和自杀行为)的影响；以及(5)调查乌干达艾滋病毒服务中的求助行为和服务提供方面的差距。这些目标将通过对乌干达城市和农村两个儿科艾滋病毒诊所的1260名CA-HIV及其照顾者进行的队列研究来实现。社会人口学特征以及心理社会、临床、遗传和生物数据将由训练有素的精神科研究护士和研究临床医生在基线和6个月和12个月的随访中收集。在队列中，我们将对48名被诊断为精神障碍(PD)的CA-HIV患者及其照顾者进行定性的子研究，以调查PD求助行为、未得到满足的护理需求和对精神健康服务的期望的解释模式。将在基线评估的两个月内和在12个月的后续行动中进行两次面谈。乌干达的艾滋病毒护理服务目前正在从垂直护理结构过渡到完全融入以艾滋病毒/艾滋病患者需要为重点的正规保健系统。这项及时研究的结果将为政策制定者和服务提供者提供宝贵的信息，以加强为这一弱势群体提供适当和有效的精神保健。

HIV disproportionately affects children and adolescents in sub-Saharan Africa, where 90% of those infected reside. In Uganda, the country with the fifth highest prevalence rate in the region, more than 10% of the 1.2 million people living with HIV are under the age of 15. In addition to its physical impact, HIV infected children and adolescents (CA-HIV) report poor mental wellbeing. Epidemiological research from high-income countries has found high rates of psychiatric disorder (PD; e.g. depression, anxiety and behaviour disorders). Evidence on risk factors for PD in CA-HIV remains inconclusive. However, potential risk factors include: poor maternal health; HIV disease severity; caregiver PD; HIV related neurological/developmental disability; stigma, death in the family and negative environmental factors; pain; and genetic factors. Although sub-Saharan Africa shoulders the greatest burden of youth HIV, little research has been conducted to better understand psychiatric problems among CA-HIV in the region. The aim of this study is to investigate the impact of PD on CA-HIV in Uganda and the implications for service provision. The objectives of this study are to: (1) determine the prevalence, 12-month incidence and predictors of PD (including neurocognitive impairment) among CA-HIV; (2) investigate the relationship between differences in the serotonin transporter gene and depressive disorder; (3) examine the impact of PD on HIV disease progression; (4) examine the impact of PD on social and academic functioning and risky behaviours (i.e. treatment adherence, alcohol use, sexual behaviour and suicidal behaviour); and (5) investigate help-seeking behaviour and identify service delivery gaps in Ugandan HIV services. These objectives will be met through a cohort study of 1,260 CA-HIV and their caregivers from two paediatric HIV clinics in urban and rural Uganda. Socio-demographic characteristics and psychosocial, clinical, genetic and biological data will be collected by trained psychiatric research nurses and study clinicians at baseline and six and 12 month follow-up. Nested in the cohort, we will carry out a qualitative sub-study of 48 CA-HIV diagnosed with a psychiatric disorder (PD) and their caregivers to investigate explanatory models of PD help-seeking behaviour, unmet needs of care and expectations from mental health care services. Interviews will be conducted on two occasions, within two months of baseline assessment and at 12 month follow-up.HIV care services in Uganda are currently in the process of transitioning from a vertical care structure to one fully integrated into the formal health care system which focuses on the needs of people living with HIV/AIDS. The results of this timely study will provide policymakers and service providers with invaluable information to strengthen the provision of appropriate and effective mental health care for this vulnerable group.