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

描述(由申请人提供)：在艾滋病毒流行的南非，艾滋病毒风险和家庭中的抑郁症对一个全球艾滋病毒流行最严重的国家构成了重大的公共卫生挑战。在这些家庭中，青少年感染艾滋病毒和抑郁症的风险增加。此外，他们的成年照顾者(亲生或代孕父母)患抑郁症的风险也在不断上升。越来越多的证据表明，艾滋病毒危险行为和抑郁的家庭风险和保护因素，突显了家庭预防方法的必要性。然而，在艾滋病毒流行社区，家庭预防科学方面存在重大差距。现有的家庭预防很少在一个综合模式中针对艾滋病毒风险和抑郁症；强调以复原力为基础的方法；并适用于南非。K01的科学目标是将艾滋病毒风险(Keepin‘It Real)和抑郁症(Family Talk)的两个经验性支持的模型整合到适用于南非的统一家庭预防干预中，并测试最初的可接受性和可行性。K01的培训目标是获得强化的指导培训，使PI成为艾滋病毒流行社区儿童和照顾者的性和心理健康弹性家庭预防干预方面的领先研究人员。培训培养了家庭预防干预方法方面的专门知识；培养了使预防干预措施适应南非并将其标准化为手册的技能；培养了预防干预设计和实施方面的专门知识，重点是随机对照试验研究设计；并培养了评估方案遵守情况、治疗忠实性和可接受性、机制衡量和试验效果的统计和分析技能。培训与三个研究目标有关。目标1是将针对艾滋病毒风险和抑郁症的两种现有预防性干预措施纳入一个统一的模式，并调整其内容和语言，使之适合南非。目标1将通过与照顾者(18岁以上)和青少年(13-15岁)的焦点小组以及与精神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将预防性干预标准化为手册，并对促进者进行培训，目标3评估招募和保留干预措施的可行性和可接受性。目的3随机抽取124名照顾者-青少年二元组(预防干预组62对，对照组62对)，在基线、干预后即刻和干预后3个月进行评估。这些发现为在全功率随机对照试验中进行预防性干预试验的未来计划提供了依据。这项研究通过以下方式推进NIMH的优先事项：1)提高受艾滋病毒感染家庭的心理健康服务的有效性；2)制定预防艾滋病毒感染的干预措施，并提高青少年对健康保护行为的遵守；3)制定适合年龄、语言和文化的方案；以及4)促进关于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。这项研究填补了高危人群和环境中家庭预防科学的一个重大空白。

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.