A Family-Based HIV Prevention Intervention for Preadolescents Affected by HIV

描述(由申请人提供)：该申请的总体目标是推进一系列研究计划，调查针对弱势青年人口，特别是那些艾滋病毒高危人群的行为干预，作为在学术界作为独立研究科学家的职业生涯的基础。拟议的项目具体涉及NIMH艾滋病研究部(DAR)提出的两个高度优先的领域：(1)旨在更好地了解与减少艾滋病毒风险有关的独特多层次因素的创新研究；(2)旨在了解受艾滋病毒影响的儿童的心理社会需求的预防科学。在实现这些目标的过程中，拟议的研究审查了易受艾滋病毒感染的特定青年群体、母亲感染艾滋病毒(MLH)的青春期前(和青春期)子女。这些儿童通过与艾滋病毒有关的危险行为的遗传和环境传播，面临通过行为获得艾滋病毒感染的风险。由于MLH的寿命比前几十年更长，因此比以往任何时候都有更多的儿童患有MLH。从艾滋病毒预防的角度审视这一不断增长的青年人口的研究很少。为了实现NIMH的目标，该项目建议调整现有的循证干预措施，以适应MLH儿童。在这样做的过程中，它审查了与艾滋病毒有关的家庭层面的具体因素，这些因素与受艾滋病毒影响的青年的性风险有关。它建议MLH处于独特的地位，通过保护性育儿做法降低其子女的艾滋病毒风险--包括促进关于艾滋病毒、艾滋病毒披露和性行为的讨论，提供监测和监督形式的结构I，以及建立健康的亲子关系。据推测，通过加强保护性育儿实践，MLH儿童的性态度、知识、意图和行为将发生变化，这将降低他们感染艾滋病毒的风险。为了验证这一假设，提出了三个具体目标：(1)通过结构化的适应过程，对青少年MLH进行基于家庭的干预；(2)对10-15岁的青少年及其MLH队列实施干预；(3)评估干预的效果。该项目侧重于居住在佐治亚州亚特兰大及其周围的MLH儿童二人组，主要是非裔美国人，并通过与当地非政府组织的合作，在研究的两个阶段招募这些二人组。第一阶段采用定性的方法，以焦点小组和个别访谈的形式，向MLH及其子女通报干预措施的进展情况。第二阶段样本60个MLH二联体，一半将接受干预，另一半将作为对照。所有第二阶段的参与者在干预前和干预后进行评估，并探讨育儿和青少年的性风险结果。结果将有助于(1)将这一干预措施扩大到更大规模，(2)使EBI适应特定的脆弱人群的过程，以及(3)我们对受艾滋病毒影响的儿童中青年艾滋病毒风险的理解，包括家庭因素。

DESCRIPTION (provided by applicant): The overarching goal of this application is to advance a programmatic line of research investigating behavioral interventions for vulnerable youth populations, specifically those at-risk for HIV, to serve as the foundation for a career in academia as an independent research scientist. The proposed project specifically addresses two areas of high priority put forth by NIMH's Division of AIDS Research (DAR): (1) innovative research designed to better understand unique multilevel factors related to HIV-risk reduction, and (2) prevention science aimed at understanding the psychosocial needs of children affected by HIV. In addressing these objectives the proposed study examines a specific population of youth vulnerable to HIV infection, preadolescent (and adolescent) children of mothers living with HIV (MLH). These children are at risk for behaviorally-acquired HIV infection through genetic and environmental transmission of HIV-related risk behaviors. Because MLH are living longer than they were in previous decades, more children are living with MLH than ever before. Research that examines this growing population of youth under a lens of HIV prevention is scarce. To address NIMH's objectives, the project proposes adapting an existing evidence-based intervention to children of MLH. In doing so it examines specific HIV-related family-level factors associated with the sexual risk of youth affected by HIV. It proposes that MLH are in a unique position to reduce their children's HIV risk through protective parenting practices-including, facilitating discussions about HIV, HIV disclosure, and sexuality, providing structure i the form of monitoring and supervision, and building a healthy parent-child relationship. It is hypothesized that through strengthening protective parenting practices, children of MLH will have shifts in sexual attitudes, knowledge, intentions, and behavior, which will reduce their risk for HIV infection. To test this hypothesis, three Specific Aims are proposed: (1) adapt a family-based intervention for youth of MLH through a structured process of adaptation, (2) implement the intervention with a cohort of youth (ages 10 to 15 years-old) and their MLH, and (3) evaluate the effects of the intervention. The project focuses on MLH-child dyads, primarily African-American, living in and around Atlanta, GA, and through collaboration with local non-governmental organizations (NGOs), recruits these dyads for two phases of the study. Phase I uses qualitative methodology in the form of focus groups and individual interviews with MLH and their children to inform the development of the intervention. Phase II samples 60 MLH dyads, half will receive the intervention and half will serve as controls. All Phase II participants are assessed pre- and post-intervention and parenting and youth sexual risk outcomes are explored. Results will inform (1) the expansion of this intervention to a larger-scale, (2) the process of adapting EBI's to specific, vulnerable populations, and (3) our understanding of youth HIV risk in children affected by HIV, including family factors.