HIV Prevention for Batswana Youth: Adaptation of an Evidence-Based Intervention

描述(申请人提供)：博茨瓦纳的艾滋病毒流行率位居世界第二，在30-34岁的人群中达到40.2%的峰值。博茨瓦纳在提供普遍免费使用AZT、预防母婴传播、广泛的VCT中心网络以及全国范围内的男性包皮环切术计划方面也处于世界领先地位。然而，这种对病例发现、护理和治疗的生物医学战略的重视并没有与初级预防计划相平行。将于2010年发布的新的国家战略计划现在将引进和适应循证行为预防作为近期的最高战略优先事项。正是为了响应新的战略计划，提交了这份合作的R34提案，以适应和试点一项以证据为基础的计划，即成为负责任的青少年(BART)干预计划，针对博茨瓦纳青年。在青少年咨询委员会和社区咨询委员会的指导下，我们将在第一年与青少年开展重点小组，并深入访谈主要信息者，以了解加巴龙中学14-19岁青少年的测量方案和干预措施的适应情况。在第二年，将对措施进行试点测试，以确定他们的心理测量特性，并比较不同性别的反应。将起草角色扮演小插曲，评估其社会和生态有效性，并将为博茨瓦纳青少年调整BART干预措施。将增加新的适合文化的模块，将酒精作为风险因素，解决冲突以减少亲密伴侣的暴力，以及减少耻辱。此外，还将增加针对父母的新的3节干预和针对家庭照顾者的单独3节计划，解决艾滋病毒/艾滋病信息，与青年就敏感话题进行交流，并在第三年监测一项试点可行性研究，将评估招募、保留、干预者的忠诚度，以及青年和父母/照顾者对各自干预措施的反应，以及结果是否表明，与中学现有的生活技能课程相比，博茨瓦纳版本的BART提供了附加值。这一开发应用是博茨瓦纳大学、哈博罗内的政府机构和非政府组织以及密西西比州立大学合作制定的方案序列的第一步。如果可行性试验记录了行为的积极变化，它将通知R01申请一项包含认知、行为和生物终点的更大规模的随机对照试验。如果RCT提供了有效的有力证据，我们将与教育部、卫生部、青年和文化部合作，在博茨瓦纳的所有中学传播这一干预措施，并培训每个社区的工作人员，以忠实地实施该计划。

DESCRIPTION (provided by applicant): Botswana has the 2nd highest HIV prevalence in the world, peaking at 40.2% in 30-34 year olds. Botswana also has been the world's leader in providing universal free access to AZT, prevention of mother to child transmission, an extensive network of VCT centers, and a nationwide male circumcision program. However, this emphasis on biomedical strategies for case finding, care, and treatment has not been paralleled by primary prevention programs. The new national strategic plan to be issued in 2010 now places importation and adaptation of evidence-based behavioral prevention as the highest strategic priority for the immediate future. It is in response to the new strategic plan that this collaborative R34 proposal to adapt and pilot an evidence-based program, the Becoming a Responsible Teen (BART) intervention, for Batswana youth is submitted. Guided by a teen advisory committee and a community advisory board, we will conduct focus groups with youth and in-depth interviews with key informants in the first year to inform adaptation of the measurement protocol and intervention for youths 14-19 in Gabarone secondary schools. In the 2nd year, measures will be pilot tested to establish their psychometric properties and to compare responses by gender. Role play vignettes will be drafted, their social and ecological validity assessed, and the BART intervention will be adapted for Batswana adolescents. New culturally appropriate modules addressing alcohol as a risk factor, conflict resolution to reduce intimate partner violence, and stigma reduction will be added. In addition, a new 3-session intervention for parents and a separate 3-session program for household caretakers will be added, addressing HIV/AIDS information, communicating with youth on sensitive topics, and monitoring, In the 3rd year, a pilot feasibility study will assess recruitment, retention, interventionists' fidelity, and youth and parents/caretakers' response to their respective interventions, and whether the results suggest that the Botswana version of BART provides value added when compared against the existing Life Skills curriculum in the secondary schools. This developmental application is the first step in a programmatic sequence developed in collaboration between the University of Botswana, governmental agencies and NGOs in Gaborone, and Mississippi State University. If the feasibility trial documents positive changes in behavior, it will inform a R01 application for a larger randomized controlled trial with cognitive, behavioral and biological endpoints. If the RCT provides strong evidence of effectiveness, we will work with the Ministries of Education, Health, and Youth and Culture to disseminate the intervention throughout Botswana's secondary schools and train staff in each community to deliver the program with fidelity.