Adapting CHAMP+ for South Africa: Supporting HIV-Infected Youth and Families

说明(申请人提供)：艾滋病毒是对儿童健康和心理社会福祉的重大威胁，特别是在资源少的国家，这些国家获得抗逆转录病毒治疗的机会有限，因此艾滋病毒在围产期的传播率很高。南非是世界上艾滋病毒感染率最高的国家之一。最近，启动了一项在南澳广泛提供抗逆转录病毒治疗的国家计划，这将导致越来越多的儿童存活下来，他们必须与艾滋病毒疾病一起生活，这是一种慢性、耻辱和可传播的疾病，有可能对公共卫生造成重大影响。艾滋病毒预防和青少年心理健康合作项目最初是在美国为未感染艾滋病毒的青少年制定的，后来被修改为适合围产期感染艾滋病毒的青少年，以防止危险行为和促进心理健康(CHAMP+)。拟议的研究将调整、完善和试点这一针对9-13岁围产期感染艾滋病毒的SA的家庭干预措施(CHAMP+SA)，并将检查1)CHAMP+SA的文化和背景适应过程以及2)CHAMP+SA对a)青年的短期近期结果(例如，应对、艾滋病毒知识、自尊)和b)家庭/社会过程(例如，沟通、支持、监督)变量的促进c)青年行为健康结果(例如，心理健康、ART坚持以及减少性和毒品风险行为)的初步影响。我们将在第一阶段(第一年)使用以社区为基础的参与性研究(CBPR)方法，使干预措施适应为艾滋病毒+青少年提供医疗和心理社会治疗的SA背景。调查小组将通过与消费者(艾滋病毒阳性青少年及其照顾者)和医疗保健提供者进行一系列咨询，调整课程和学习程序，与护理人员、艾滋病毒顾问和主要负责德班麦考德医院心理社会项目的心理学实习生密切合作，本研究将在那里进行。在第二阶段(第二年)，我们将对30个在医院接受护理的家庭进行CHAMP+SA的小型随机试验。他们将被随机分为干预或延迟干预两种情况。在修正的社会行动理论模型的指导下，参与者将接受测试前后的行为健康结果、青少年自我调节、家庭过程和背景变量的评估。还将收集与适应和实施CHAMP+SA有关的过程变量，包括可行性和可接受性的障碍和促进者。这一发现可用于在类似环境下进行更大规模的有效性研究。

DESCRIPTION (provided by applicant): HIV is a major threat to the health and psychosocial well-being of children, particularly in low-resource countries that have had limited access to antiretroviral treatments (ART) and thus high rates of perinatal HIV transmission. South Africa (SA) has one of the highest HIV prevalence rates in the world. Recently, a national plan was initiated to make ART widely available in SA which will result in a growing population of children who survive and must live with HIV disease as a chronic, stigmatizing, and transmittable illness, with the potential for significant public health consequences. The Collaborative HIV Prevention and Adolescent Mental Health Projects or CHAMP was originally developed in the United States (US) for un-infected youths and was subsequently adapted for perinatally HIV-infected youths to prevent risk behavior and promote mental health (Champ+). The proposed study will adapt, refine, and pilot test this family based intervention for SA perinatally HIV-infected 9-13 year-olds (Champ+SA) and will examine 1) the process of cultural and contextual adaptation of CHAMP+SA and 2) the preliminary impact of Champ+ SA on short term proximal outcomes for a) youth (e.g., coping, HIV knowledge, self esteem) and b) family/social process (e.g., communication, support, supervision) variables that promote c) youth behavioral health outcomes (e.g., mental health, ART adherence, and reduction of sexual and drug risk behavior). We will use a community-based participatory research (CBPR) approach in Phase 1(Year 1) to adapt the intervention to the SA context of medical and psychosocial treatment for HIV+ youth. The investigative team will adapt the curriculum and study procedures via a series of consultations with consumers (HIV+ youth and their caregivers), and health care providers, working closely with nursing staff, HIV counselors, and psychology trainees who are primarily responsible for psychosocial programs at McCord Hospital in Durban, where this study will take place. In Phase 2 (Year 2), we will conduct a small randomized trial of CHAMP+SA with 30 families in care at the Hospital. They will be randomized to either the intervention or a delayed intervention condition. Guided by a modified Social Action Theory model, participants will be assessed --pre- and post-test on behavioral health outcomes, youth self- regulation, family process and contextual variables. Process variables related to the adaptation and implementation of CHAMP+SA, including barriers and facilitators of feasibility and acceptability will also be collected. The findings can be used to inform larger-scale effectiveness studies in similar settings.