Shaping the Health of Adolescents in Zimbabwe (SHAZ!)

描述（由申请人提供）：津巴布韦正面临着艾滋病毒普遍流行和经济迅速衰退的协同瘟疫。这两项措施造成了大量孤儿和弱势儿童，2007年估计达150万人。孤儿和易受感染儿童的青少年女性获得教育和经济机会的机会有限，感染艾滋病毒的可能性是同龄男性的两倍，并且比非孤儿和易受感染儿童更有可能从事高风险性行为。在艾滋病毒感染者中，经济脆弱性以及贫穷和艾滋病毒阳性带来的心理后果，增加了二次传播的风险和难以获得护理的机会。显然需要在这一脆弱群体中开展二级预防（艾滋病毒传播和与艾滋病毒有关的心理疾病）;然而，现有的行为干预措施可能影响有限，因为它们没有解决影响行为的基本经济因素。至关重要的是，必须制定和评价确实针对这些因素的结构性干预措施。通过这一延续性建议，我们建议扩大SHAZ！（塑造津巴布韦青少年的健康）-一项艾滋病毒预防干预措施，通过改善经济机会并将其与基于生活技能的艾滋病毒教育和临床护理联系起来，使青少年女性孤儿和易受感染儿童能够避免危险性行为。在20名艾滋病毒阳性参与者中开展试点工作的基础上，将其纳入SHAZ！研究，在这里，我们建议进行全面的研究“SHAZ！在另外650名艾滋病毒阳性参与者中开展”积极的人“活动，所有这些人都将与临床护理联系起来，然后随机分配到经济（职业培训，指导咨询和小额赠款）和生活技能综合干预组，与单独的生活技能干预组相比。在主要研究进行期间（目标是在2009年初完成）启动这一扩展，将使我们能够在现有基础设施的基础上进一步发展，从而节省大量成本，并隐藏研究参与者的艾滋病毒状况，促进我们确保保密的道德要求。通过我们提出的设计，汇集了RTI国际，津巴布韦大学UCSF研究计划，泛大陆全球艾滋病基金会和艾滋病毒/艾滋病诊所在奇通维萨医院妇女的全球健康当务之急，我们将评估SHAZ的效果！对于阳性：（1）经济生计和社会资源的指标;（2）坚持护理和治疗，以及随后的健康结果;（3）心理社会发病率，披露和应对技能;（4）与艾滋病毒二次传播相关的行为，以及（4.a）二次传播风险行为是否由治疗结果或心理社会因素介导。如果这个创新的SHAZ！积极的模式被证明是有效的，这些发现将在该地区和其他地区产生深远的计划和政策影响。

DESCRIPTION (provided by applicant): Zimbabwe is confronting the synergistic plagues of a generalized HIV epidemic and rapid economic decline. Both have contributed to the large number of orphans and vulnerable children (OVC) estimated at 1.5 million in 2007. Adolescent female OVC have limited access to educational and economic opportunities, are twice as likely to be HIV infected than their male counterparts, and are more likely than non-OVC to engage in high-risk sexual behavior. Among those that are HIV infected, economic vulnerability and the psychological consequences of being poor and HIV positive, increase the risk of secondary transmission and poor access to care. There is a clear need to address secondary prevention (of HIV transmission and of HIV- related psychological morbidity) in this vulnerable population; however, existing behavioral interventions are likely to have limited impact in that they do not address the fundamental economic factors conditioning behavior. It is critical that structural interventions that do address such factors be developed and evaluated. Through this continuation proposal, we propose to expand SHAZ! (Shaping the Health of Adolescents in Zimbabwe)-an HIV prevention intervention that empowers adolescent female OVC to avoid sexual risk behaviors by improving economic opportunities and linking them to life skills-based HIV education and clinical care-to HIV-positive participants. Building on pilot work among 20 HIV-positive participants integrated into the SHAZ! study, here we propose to conduct a full study of "SHAZ! for Positives" among 650 additional HIV-positive participants, all of whom will be linked to clinical care and then randomly assigned to the combined economic (vocational training, guidance counseling, and a micro-grant) and life skills intervention compared to the life skills intervention alone. Initiating this expansion while the main study is ongoing (targeted for completion in early 2009) will enable us to build on our existing infrastructure and, thus, effect substantial cost savings, as well as conceal the HIV status of study participants, facilitating our ethical mandate to ensure confidentiality. Through our proposed design-that brings together the Women's Global Health Imperative at RTI International, the University of Zimbabwe-UCSF Research Programme, the Pangaea Global AIDS Foundation and the HIV/AIDS clinic at the Chitungwiza Hosptial-we will evaluate the effect of SHAZ! for Positives on: (1) indicators of economic livelihoods and social resources; (2) adherence to care and treatment, and subsequent health outcomes; (3) psychosocial morbidity, disclosure, and coping skills; (4) behaviors associated with the secondary transmission of HIV, and (4.a) whether secondary transmission risk behavior is mediated by treatment outcomes or psychosocial factors. If this innovative SHAZ! for Positives model is proven effective, these findings will have far-reaching program and policy implications in the region and beyond.