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

描述（由申请人提供）：艾滋病毒是对儿童健康和心理健康的主要威胁，特别是在资源匮乏的国家，这些国家获得抗逆转录病毒治疗（ART）的机会有限，因此围产期艾滋病毒传播率很高。南非是世界上艾滋病毒感染率最高的国家之一。最近，启动了一项国家计划，使抗逆转录病毒疗法在南澳大利亚州广泛使用，这将导致越来越多的儿童幸存下来，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，有可能造成重大的公共卫生后果。艾滋病毒预防和青少年心理健康合作项目（CHAMP）最初是在美国为未感染的青少年开发的，后来被改编为围产期艾滋病毒感染的青少年，以预防危险行为和促进心理健康（Champ+）。拟议的研究将适应，完善和试点测试这种以家庭为基础的干预SA围产期艾滋病毒感染的9-13岁（Champ+SA），并将检查1）CHAMP+SA的文化和背景适应过程和2）Champ+ SA对短期近端结果的初步影响a）青年（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，促进c）青年行为健康结果（例如，心理健康、ART坚持以及减少性和药物风险行为）。我们将在第1阶段（第1年）使用基于社区的参与性研究（CBPR）方法，以使干预措施适应艾滋病毒阳性青年的医疗和心理社会治疗的SA背景。调查小组将通过与消费者（艾滋病毒阳性青年及其护理人员）和卫生保健提供者的一系列协商，与护理人员，艾滋病毒咨询师和心理学学员密切合作，调整课程和研究程序，这些人员主要负责德班McCord医院的心理社会项目，本研究将在那里进行。在第2阶段（第2年），我们将在医院的30个家庭中进行一项CHAMP+SA的小型随机试验。他们将被随机分配到干预或延迟干预条件。在社会行动理论模型的指导下，参与者将被评估-前和后测试的行为健康结果，青年自我调节，家庭过程和背景变量。还将收集与CHAMP+SA的适应和实施有关的过程变量，包括可行性和可接受性的障碍和促进因素。研究结果可用于在类似环境中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.