HIV and Substance Use Prevention for South African Youth and Families

描述（由申请人提供）：南非（SA）是世界上艾滋病毒/艾滋病（PLWHA）感染者人数最多的国家。南非的年轻人正在经历新的艾滋病毒感染增长最快的情况，而在西开普省地区，新的感染越来越多地受到心理健康问题和药物使用的影响。家庭可以成为艾滋病毒预防工作的有效合作者，但南非青少年，特别是那些有心理健康问题和吸毒/酗酒的青少年，没有基于家庭的干预措施。这项发展研究将适应和试点测试一个多层次的，非常有前途的，艾滋病毒和酒精/药物使用预防计划（项目风格）的南非照顾者和他们的青少年接受门诊心理健康服务。项目风格的设计和测试与750名精神病患者的青少年在美国三个城市，我们将系统地适应南非的情况下使用ADAPT-ITT和CDC的指导方针相结合。第一阶段将涉及广泛的形成性工作（例如，焦点小组、反馈小组、深入访谈、剧场测试）、修订调查工具和课程，以及翻译/回译成南非荷兰语和科萨语。我们将组建一个CAB，在调整和修订中提供建议。在第二阶段，我们会以两组接受精神健康服务的14至18岁青少年家长为对象，进行经修订的干预试验。青少年将是来自所有种族群体的男性和女性（即，白色、黑色和彩色）。我们将根据全面的参与者评估、观察和主持人评级修改研究程序和材料。在第三阶段，我们将重新测试修订后的计划与60个父母-青少年配对随机分配到项目风格与对照组。所有参与者将完成基线和3个月的随访访谈，以评估跟踪，保留和初步治疗效果。在艾滋病毒风险的社会-个人框架6和性别与权力理论的指导下，干预措施将针对个人属性、同伴和伙伴关系过程以及家庭环境，以减少南非青年的危险性行为和吸毒/酗酒。鉴于本研究的探索性性质，我们将谨慎地研究理论中介和危险性行为和药物滥用的变化作为项目参与的函数，我们将确定项目对组间HIV风险行为影响的前测-后测效应大小。这项研究的长期目标是为南非青少年和父母制定一个非常有前途和基于科学的艾滋病毒和药物使用预防计划，可以在大规模的有效性研究中进行测试。本研究符合R34指南，以支持干预开发的早期阶段和初步测试，以检查可行性，可接受性和耐受性。 公共卫生相关性：撒哈拉以南非洲是全球艾滋病流行的中心，据估计，南非是世界上艾滋病毒/艾滋病感染者人数最多的国家。在南非，青年人是艾滋病毒新感染人数增长最快的群体，因此遏制传播是全球公共卫生的优先事项。不幸的是，全国的努力令人失望; 50%的南非青年有过性经验，25%的人以前被诊断患有性病，40%的人报告涉及血液的性活动。同样，青少年使用酒精和其他毒品的比率也在上升，而且大多数（54%）初次使用毒品的年龄（13 - 16岁）是年轻人。同样，尽管接受精神病护理的青少年中存在高风险行为，世界卫生组织也声明“没有心理健康就没有健康”，但心理健康在南非一直是一个低优先事项。南非人中艾滋病毒感染率不成比例可能部分反映了可用的精神卫生服务很少，而改善精神卫生保健可能会减少艾滋病毒/艾滋病的传播。在南非西开普省，冒险性行为、酗酒和吸毒以及精神疾病之间的联系正在助长青年人感染艾滋病毒/艾滋病。家庭可以成为艾滋病毒预防工作的有效合作者，但南非青少年，特别是那些有心理健康问题和吸毒/酗酒的青少年，没有基于家庭的干预措施。这项发展研究将适应和试点测试多层次的，非常有前途的，艾滋病毒和酒精/药物使用预防计划（项目风格），为这个特别高风险的人群。同时解决南非青年中的性风险、心理健康和药物使用问题，有可能减少这些相互交叉的流行病。拟议项目的长期目标是制定一个经过实践验证的、以理论为基础的、以家庭为重点的艾滋病毒和药物使用预防方案，以减少有精神健康问题的南非青年的健康风险行为。

DESCRIPTION (provided by applicant): South Africa (SA) has the largest number of people living with HIV/AIDS (PLWHA) in the world. Youth in SA are experiencing the fastest increase in new HIV infections, and in the Western Cape region, new infections are increasingly fueled by mental health problems and substance use. Families can be effective collaborators in HIV prevention efforts, but no family-based interventions exist for South African teens, particularly those with mental health problems and drug/alcohol use. This developmental study will adapt and pilot test a multi-level, highly promising, HIV and alcohol/drug use prevention program (Project STYLE) for South African caregivers and their teens receiving outpatient mental health services. Project STYLE was designed and tested with 750 mentally ill teens across three US cities, and we will systematically adapt it for the South African context using a combination of ADAPT-ITT and CDC guidelines. Stage 1 will involve extensive formative work (e.g., focus groups, feedback groups, in-depth interviews, theater testing), revisions to survey instruments and the curriculum, and translation/back-translation into Afrikaans and isiXhosa. We will assemble a CAB to advise in the adaptations and revisions. In Stage 2, we will pilot test the revised intervention with two groups of 14 - 18 year old parent-teen dyads receiving mental health services. Teens will be male and female from all ethnic groups (i.e., White, Black, and Colored). We will revise study procedures and materials based on comprehensive participant evaluations, observations, and facilitator ratings. In Stage 3, we will re-test the revised program with 60 parent-teen dyads randomly assigned to Project STYLE versus a control group. All participants will complete baseline and 3-month follow-up interviews to evaluate tracking, retention, and preliminary treatment effects. Guided by a Social-Personal framework6 of HIV-risk and the Theory of Gender and Power, the intervention will target personal attributes, peer and partner relationship processes, and family context to reduce risky sexual behavior and drug/alcohol use among South African youth. Given the exploratory nature of the study, we will cautiously examine change in theoretical mediators and risky sexual behavior and substance abuse as a function of program participation, and we will determine the pretest-posttest effect size of program impact on HIV-risk behavior between groups. The long-term goal of the study is to adapt a highly promising and scientifically-based HIV and substance use prevention program for South African teens and parents that can be tested in a large-scale effectiveness study. This study is consistent with R34 guidelines to support the early phase of intervention development and preliminary testing to examine feasibility, acceptability, and tolerability. PUBLIC HEALTH RELEVANCE: Sub-Saharan Africa is the global epicenter of the AIDS epidemic, and South Africa is estimated to have the largest number of people living with HIV/AIDS in the world. With youth experiencing the fastest increase in new HIV infections in South Africa, stemming transmissions is a global public health priority. Unfortunately, national efforts have been disappointing; 50% of South African youth are sexually experienced, 25% were previously diagnosed with an STI, and 40% report sexual activity involving blood. Similarly, adolescent rates of alcohol and other drug use are rising, and age at first use (13 - 16 years old) for the majority (54%) is young. Likewise, despite high-risk taking among teens in psychiatric care, and the World Health Organization's statement that "there can be no health without mental health," mental health has been a low priority in South Africa. Disproportionate rates of HIV infection among South Africans may reflect, in part, few available mental health services, while improved mental health care may reduce the spread of HIV/AIDS. In the Western Cape region of South Africa, associations among sexual risk taking, alcohol and drug use, and mental illness are fueling HIV/AIDS infections among youth. Families can be effective collaborators in HIV prevention efforts, but no family-based interventions exist for South African teens, particularly those with mental health problems and drug/alcohol use. This developmental study will adapt and pilot test a multi-level, highly promising, HIV and alcohol/drug use prevention program (Project STYLE) for this exceptionally high-risk population. Simultaneously addressing sexual risk taking, mental health, and substance use among South African youth has the potential to reduce these intersecting epidemics. The long-term goal of the proposed project is to develop an empirically-validated, theoretically-based family-focused HIV and substance use prevention program to reduce health risk behavior among South African youth with mental health problems.