Mental Health and Risk in HIV+ Youth and Seroreverters

描述(由申请人提供)：拟议的五年研究的目标是1)确定围产期艾滋病毒感染青少年中精神疾病和行为健康结果的流行率，包括情绪和行为功能、艾滋病毒危险行为和坚持用药；2)通过比较围产期艾滋病毒感染青年和在子宫中暴露于艾滋病毒的未感染青年(血清转换者)，检查艾滋病毒感染与精神疾病和行为健康结果之间的联系；以及3)确定两组预期在18个月以上的行为健康结果相关的风险和保护因素。为了实现研究目标，我们将对200名围产期感染艾滋病毒的儿童和150名9-16岁的血清转换者进行为期五年的纵向研究，他们居住在纽约市，纽约是美国妇女和儿童艾滋病毒流行的中心之一。拟议的700名参与者将包括儿童(n=350)及其主要照顾者(n=350)。将使用两个数据来源：1)保育者和儿童访谈以及2)医疗图表摘要(淋巴细胞亚群、艾滋病毒RNA病毒载量、疾控中心诊断、抗逆转录病毒治疗、医疗服务利用)。每个参与者都将在基线和18个月的随访中接受单独面谈。在社会行动理论的指导下，访谈将评估精神障碍、行为健康结果以及行为健康结果的一系列决定因素。这些决定因素包括个人的自我调节过程以及更大的社会、家庭、个人和环境背景。在拟议的研究中，我们强调儿童的艾滋病毒状况和精神功能以及家庭因素(沟通、监督和参与)在影响行为健康结果方面的重要性。参与者将从纽约市的四个主要医疗中心招募，每个中心都为感染艾滋病毒的儿童和血清转换者提供全面的医疗和心理健康护理。这些诊所的患者主要是非洲裔美国人和拉丁裔，生活在市中心社区的贫困中，艾滋病毒血清阳性率和吸毒率很高，这反映了儿科艾滋病毒的流行。这项拟议的研究将让我们了解精神健康问题的具体压力源和相关因素，以及这一人群中的艾滋病毒危险行为。因此，这将是为美国和发展中国家迅速崛起的新风险群体制定有效干预措施的关键一步，这些人群获得治疗和其他资源的机会有限。

DESCRIPTION (provided by applicant): The goals of the proposed five year study are to 1) determine the prevalence of Psychiatric Disorders and Behavioral Health Outcomes, including emotional and behavioral functioning, HIV risk behaviors, and adherence to medication in perinatally HIV-infected adolescents; 2) examine the association between HIV infection and Psychiatric Disorders and Behavioral Health Outcomes by comparing perinatally HIV-infected youth to uninfected youth exposed to HIV in utero (seroreverters); and 3) identify risk and protective factors related to Behavioral Health Outcomes in both groups prospectively over 18 months. To achieve the study goals, we will conduct a five year, longitudinal study of 200 perinatally HIV-infected children and 150 seroreverters, ages 9 - 16 years, residing in NYC, one of the epicenters of the HIV epidemic among women and children in the US. The proposed sample of 700 participants will consist of the child (n = 350) and his/her primary caregiver (n = 350). Two sources of data will be used: 1) caregiver and child interviews and 2) medical chart abstraction (lymphocyte subsets, HIV RNA viral load, CDC diagnosis, antiretroviral treatment, medical service utilization). Each participant will be individually interviewed at baseline and 18-month follow-up. The interview, guided by Social Action Theory, will assess Psychiatric Disorders, Behavioral Health Outcomes, and a range of determinants of Behavioral Health Outcomes. These determinants consist of the individual's self-regulation processes and the larger social, family, individual, and environmental context. In the proposed study, we emphasize the importance of the child's HIV status and psychiatric functioning as well as family factors (communication, supervision, and involvement) in influencing Behavioral Health Outcomes. Participants will be recruited from four major medical centers in NYC, each of which provides comprehensive medical and mental health care to HIV-infected children and seroreverters. Reflecting the pediatric HIV epidemic, the patients in these clinics are primarily African American and Latino, living in poverty in inner-city communities, with high HIV seroprevalence and rates of drug use. The proposed study will inform us about the specific stressors and correlates of mental health problems, as well as HIV risk behavior in this population. Thus, it will be a critical step in the development of effective interventions for a population that is fast emerging as a new risk group both in the US and in developing countries with 'limited access to treatment and other resources.