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）确定精神疾病和行为健康结局的患病率，包括围产期HIV感染青少年的情绪和行为功能、HIV风险行为和药物依从性; 2）通过比较围产期HIV感染与精神疾病和行为健康结果之间的关系，受感染的青年与未受感染的青年在子宫内暴露于HIV（血清逆转者）; 3）在18个月内前瞻性地确定两组中与行为健康结局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HIV感染儿童和150名血清转复者进行一项为期五年的纵向研究，年龄在9 - 16岁之间，居住在纽约市，纽约市是美国妇女和儿童HIV流行的中心之一。拟定的700名参与者样本将包括儿童（n = 350）和他/她的主要照顾者（n = 350）。将使用两个数据来源：1）护理人员和儿童访谈和2）医学图表提取（淋巴细胞亚群、HIV RNA病毒载量、CDC诊断、抗逆转录病毒治疗、医疗服务利用）。每位参与者将在基线和18个月随访时接受单独访谈。这次采访以社会行动理论为指导，将评估精神疾病、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和更大的社会，家庭，个人和环境背景。在拟议的研究中，我们强调的重要性，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）的影响行为健康的结果。参与者将从纽约市的四个主要医疗中心招募，每个中心都为艾滋病毒感染儿童和血清逆转者提供全面的医疗和心理健康护理。这些诊所的病人主要是非洲裔美国人和拉丁美洲人，他们生活在贫民区，艾滋病毒血清阳性率和吸毒率都很高，这反映了儿科艾滋病毒的流行。这项拟议中的研究将告诉我们心理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风险行为。因此，这将是制定有效干预措施的关键一步，因为在美国和发展中国家，这一人群正迅速成为一个新的风险群体，他们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.