Family Prevention of HIV Risk and Depression in HIV-endemic South Africa

描述（由申请人提供）：艾滋病毒流行的南非家庭中的艾滋病毒风险和抑郁症对全球艾滋病毒流行最严重的国家提出了重大的公共卫生挑战。在这些家庭中，青少年面临艾滋病毒和抑郁症的风险增加。此外，他们的成年照顾者（亲生父母或代理父母）也有患抑郁症的风险。越来越多的证据表明，艾滋病毒风险行为和抑郁症的家庭风险和保护因素，强调需要采取家庭预防办法。然而，艾滋病毒流行社区的家庭预防科学存在重大差距。现有的家庭预防措施很少以一种综合模式针对艾滋病毒风险和抑郁症;强调基于复原力的方法;并适合南非。本K 01的科学目标是将两个经验支持的艾滋病毒风险模型（Keepin' It真实的）和抑郁症模型（Family Talk）整合为适合南非的统一家庭预防干预措施，并测试初始可接受性和可行性。本K 01的培训目标是获得强化指导培训，使PI成为艾滋病毒流行社区儿童和护理人员性健康和心理健康恢复能力的家庭预防干预措施的主要研究人员。培训开发家庭预防干预方法的专业知识;建立技能，使预防干预措施适应南非并标准化为手册;开发预防干预设计和实施的专业知识，重点是RCT研究设计;并建立评估方案遵守情况的统计和分析技能，治疗保真度和可接受性，机制测量和试验疗效。培训与三个研究目标有关。目标1是将艾滋病毒风险和抑郁症的两种现有预防干预措施纳入一个统一的模式，并调整内容和语言以适合南非。目标1将通过与照顾者（18岁以上）和青少年（13-15岁）的焦点小组以及与心理和艾滋病毒预防专家、社区领导人和从业人员的访谈来实现。目标2将预防性干预措施编入手册，并培训辅导员。目标3评估干预措施在招聘和保留方面的可行性以及可接受性。目标3将通过随机分配124名护理人员-青少年配对（预防性干预组n=62对配对，对照组n=62对配对）并在基线、干预后即刻和干预后3个月进行评估来实现。研究结果为未来在全功率RCT中进行预防性干预试验的计划提供了信息。该研究通过以下方式推进NIMH的优先事项：1）提高受艾滋病毒影响家庭的心理健康服务的有效性; 2）制定干预措施以预防艾滋病毒感染并提高青少年对健康保护行为的坚持; 3）制定年龄，语言和文化适当的计划;以及4）促进受艾滋病毒影响的少数民族社区心理健康的多学科研究和培训。这项研究填补了家庭预防科学在高风险人群和环境中的一个重大空白。 公共卫生相关性：越来越多的证据表明，艾滋病毒流行的南非青少年及其照顾者中存在艾滋病毒风险和抑郁症，这表明迫切需要进行公共卫生研究，以保护这些环境中家庭的健康复原力。与照顾者和青少年艾滋病毒风险行为和抑郁症有关的家庭因素证明了家庭预防方法的合理性。这项研究解决了一个关键的差距，在艾滋病毒流行的社区，通过调整，标准化，并展示了初步的可行性和可接受性的背景下适当的家庭预防模式，艾滋病毒的风险行为和抑郁症的预防科学。

DESCRIPTION (provided by applicant): HIV risk and depression among families in HIV-endemic South Africa present significant public health challenges to a country with the largest HIV epidemic globally. In these families, adolescents face elevated risk for HIV and depression. Furthermore, their adult caregivers (biological or surrogate parents) are also at escalated risk fo depression. Growing evidence indicates family risk and protective factors for HIV risk behaviors and depression, underscoring the need for a family prevention approach. However, key gaps exist in family prevention science in HIV-endemic communities. Few existing family preventions target HIV risk and depression in one integrated model; emphasize a resilience based approach; and are adapted to South Africa. The scientific objective of this K01 is to integrate two empirically supported models for HIV risk (Keepin' It Real) and depression (Family Talk) into a unified family preventive intervention appropriate for South Africa and test initial acceptabilit and feasibility. The training objective of this K01 is to obtain intensive mentored training that wll prepare the PI to become a leading researcher on family preventive interventions for sexual and mental health resilience among children and caregivers in HIV-endemic communities. Training develops expertise in family preventive intervention approaches; builds skills to adapt preventive interventions to South Africa and standardize into a manual; develops expertise in preventive intervention design and implementation with a focus on RCT study designs; and builds statistical and analytical skills in assessment of protocol adherence, treatment fidelity and acceptability, mechanism measurement, and trial efficacy. Training is linked to three study aims. Aim 1 is to integrate two existing preventive interventions for HIV risk and depression into a unified model and adapt the content and language to be appropriate for South Africa. Aim 1 will be accomplished through focus groups with caregivers (18+ years) and adolescents (13-15 years) and interviews with mental and HIV prevention experts, community leaders, and practitioners. Aim 2 standardizes the preventive intervention into a manual and trains facilitators Aim 3 assesses feasibility regarding recruitment and retention and acceptability of the intervention. Aim 3 will be accomplished with randomization of 124 caregiver- adolescent dyads (n=62 dyads in the preventive intervention group, n=62 dyads in the control group) and assessments at baseline, immediately post-intervention, and three months post-intervention. Findings inform future plans for preventive intervention testing in a fully-powered RCT. The study advances NIMH priorities by 1) improving effectiveness of mental health services for HIV-affected families; 2) developing interventions to prevent HIV-infection and to improve adherence to health protective behaviors in adolescents; 3) developing age, language, and culture-appropriate programs; and 4) promoting multidisciplinary research and training on mental health of HIV-affected minority communities. The study fills a significant gap in family prevention science in a high risk population and setting. PUBLIC HEALTH RELEVANCE: Growing evidence of HIV risk and depression among adolescents and their caregivers in HIV-endemic South Africa indicates an urgent need for public health research that protects health resilience among families in these settings. Family factors linked to caregiver and adolescent HIV risk behavior and depression justify a family prevention approach. This study addresses a key gap in prevention science for HIV-endemic communities by adapting, standardizing, and demonstrating initial feasibility and acceptability of a contextually appropriate family prevention model for HIV risk behavior and depression.