HIV and Substance Use Prevention for South African Youth and Families

描述(申请人提供)：南非(南非)是世界上艾滋病病毒携带者/艾滋病患者人数最多的国家。南非的青年新感染艾滋病毒的速度最快，在西开普省地区，精神健康问题和药物使用加剧了新感染。家庭可以在艾滋病毒预防工作中成为有效的合作者，但南非青少年，特别是那些有精神健康问题和吸毒/酗酒的青少年，没有基于家庭的干预措施。这项发展研究将为接受门诊精神健康服务的南非照顾者及其青少年调整和试行一个多层次的、非常有希望的艾滋病毒和酒精/药物使用预防计划(Project Style)。项目风格是在美国三个城市的750名精神病青少年中设计和测试的，我们将使用Adapt-ITT和CDC指南的组合来系统地调整它以适应南非的背景。第一阶段将涉及广泛的形成工作(例如，焦点小组、反馈小组、深入访谈、剧院测试)，修订调查工具和课程，以及翻译/回译成南非荷兰语和伊西科萨语。我们将组织一辆出租车，为改编和修改提供建议。在第二阶段，我们将对接受心理健康服务的两组14-18岁的父母-青少年夫妇进行试点测试。青少年将是来自所有种族(即白人、黑人和有色人种)的男性和女性。我们将根据全面的参与者评估、观察和主持人评级来修改研究程序和材料。在第三阶段，我们将对修订后的计划进行重新测试，将60名家长-青少年双亲随机分配到Project Style和对照组。所有参与者都将完成基线和3个月的随访访谈，以评估追踪、保留和初步治疗的效果。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、同伴和伴侣关系进程以及家庭环境，以减少南非青年的危险性行为和吸毒/酗酒。鉴于这项研究的探索性性质，我们将谨慎地检查作为项目参与功能的理论中介和危险性行为和药物滥用的变化，并确定项目对群体之间艾滋病毒风险行为影响的前后测效应大小。这项研究的长期目标是为南非青少年和父母调整一个非常有前途的、以科学为基础的艾滋病毒和药物使用预防计划，该计划可以在大规模有效性研究中进行测试。这项研究与R34指南一致，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：撒哈拉以南非洲是艾滋病流行的全球中心，据估计，南非的艾滋病毒/艾滋病感染者人数是世界上最多的。由于南非年轻人新感染艾滋病毒的增长速度最快，遏制传播是全球公共卫生的优先事项。不幸的是，国家的努力一直令人失望；50%的南非青年有过性经验，25%的人以前被诊断为性传播感染，40%的人报告有与血液有关的性行为。同样，青少年饮酒和使用其他药物的比例正在上升，而且大多数人(54%)的首次使用年龄(13-16岁)都很年轻。同样，尽管青少年接受精神护理的风险很高，世界卫生组织也发表声明称，“没有心理健康就不可能有健康”，但在南非，心理健康一直是一个较低的优先事项。南非人中不成比例的艾滋病毒感染率可能在一定程度上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。在南非的西开普省地区，性行为风险、酒精和毒品使用以及精神疾病之间的联系正在助长青年中的艾滋病毒/艾滋病感染。家庭可以在艾滋病毒预防工作中成为有效的合作者，但南非青少年，特别是那些有精神健康问题和吸毒/酗酒的青少年，没有基于家庭的干预措施。这项发展研究将为这一异常高危人群调整和试行一个多层次的、非常有希望的艾滋病毒和酒精/药物使用预防计划(Project Style)。同时解决南非青年的性风险、心理健康和药物使用问题有可能减少这些相互交织的流行病。拟议项目的长期目标是开发一个经验证的、以理论为基础、以家庭为重点的艾滋病毒和药物使用预防计划，以减少南非有心理健康问题的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.