Improving Health Outcomes for Orphans by Preventing HIV/STD Risk.

描述(由申请人提供)：改善孤儿的结局：实施注重创伤的CBT本R01提案的主要目标是通过一项随机对照试验(RCT)，研究注重创伤的认知行为疗法(TF-CBT)在两个艾滋病毒高发区坦桑尼亚的Moshi(TZ)和肯尼亚的Bungoma(KE)的孤儿和青少年治疗创伤性悲伤和创伤性应激的有效性。低收入和中等收入国家(LAMIC)的精神健康差距很大，需要治疗的人很少得到基本护理。目前全世界有1.43亿名孤儿和青少年，其中仅撒哈拉以南非洲就有近5000万人，1660万人死于艾滋病毒/艾滋病。这些儿童是弱势儿童，父母死亡后往往会出现精神健康问题，而且创伤暴露的比率也很高。在我们对坦桑尼亚孤儿进行TF-CBT的可行性研究中，我们发现基于群体的TF-CBT干预是可行和可接受的，具有良好的临床结果。在可行性研究中，没有心理健康经验的非专业咨询师在我们的心理健康团队和TF-CBT专家的培训和监督下进行了干预。在这项初步研究的基础上，我们提出了一项随机对照试验，以测试TF-CBT治疗创伤性悲伤和创伤应激的有效性，并与在德克萨斯州和科岛接受常规护理的孤儿服务进行比较。这项研究从三个方面扩展了我们以前的工作：1)包括比较条件；2)包括两个国家，以检查更广泛的适用性和有效性；以及3)与可行性研究中经验丰富的非专业顾问合作，培训和监督非专业顾问，试图建立地方责任并采取措施实现可持续发展。拟议的研究涉及与艾滋病毒/艾滋病基层组织和德克萨斯州和柯州的当地协查人员的合作，他们都是我们美国团队的长期合作伙伴，位于城市和农村混合地区，允许在两个国家和两个环境(城市/农村)检查有效性。我们将在每个国家培训9名辅导员，他们在每个地点提供20个小组(农村10个，城市10个)，结果是320名儿童和青少年(7-13岁)接受TF-CBT，320人接受常规护理。在12-14周(即，对应于TF-CBT结束时)、治疗后6个月和治疗后12个月评估儿童的结果。我们团队中的TF-CBT专家与可行性研究中的非专业辅导员(例如，当地培训师)合作培训TZ ad KE辅导员，这些本地培训师提供TF-CBT监督，同时由美国的TF-CBT和心理健康专家监督自己。我们期望这项试验能就对孤儿的有效干预提出可接受、可行的建议，并将地方责任作为增强LAMIC潜在可持续性的一种手段。这些发现将为其他努力提供参考，以扩大精神健康干预，以解决严重的精神健康差距。

DESCRIPTION (provided by applicant): Improving Outcomes for Orphaned Youth: Implementation of Trauma-focused CBT The primary goal of this R01 proposal is to study the effectiveness of Trauma-focused Cognitive Behavioral Therapy (TF-CBT) in treating traumatic grief and traumatic stress for orphaned children and young adolescents in two East African sites with high prevalence HIV, Moshi, Tanzania (TZ) and Bungoma, Kenya (KE), through a randomized controlled trial (RCT). The mental health gap in low and middle income countries (LAMICs) is substantial, with few individuals in need of treatment receiving even basic care. Orphaned children and adolescents currently number 143 million worldwide, with nearly 50 million in Sub-Saharan Africa alone, 16.6 million due to HIV/AIDS. These are vulnerable children, who often have mental health problems subsequent to parental death as well as high rates of trauma exposure. In our feasibility study of TF-CBT with orphans in Tanzania, we have found a group-based TF-CBT intervention to be feasible and acceptable, with promising clinical outcomes. In the feasibility study, lay counselors with no prior mental health experience delivered the intervention with training and supervision by our team of mental health and TF-CBT experts. Building on this initial study, we propose a RCT to test the effectiveness of TF-CBT for traumatic grief and traumatic stress compared to receipt of usual care orphan services in TZ and KE. The study extends our prior work in three ways: 1) includes a comparison condition; 2) includes two countries to examine broader applicability and effectiveness; and 3) involves partnering with the experienced lay counselors from the feasibility study to train and supervise lay counselors, in an attempt to build local responsibility and take steps toward sustainability. The proposed study involves collaboration with HIV/AIDS grassroots organizations and local Co-Investigators in TZ and KE, both of whom are longstanding collaborators with our US team and are located in mixed urban and rural areas, allowing examination of effectiveness in two countries and two settings (urban/rural). Using a task-shifting approach, in which lay individuals are trained as counselors, we will train nine counselors in each country, who deliver 20 groups in each site (10 rural, 10 urban), resulting in 320 children and adolescents (ages 7-13) who receive TF-CBT and 320 who receive usual care. Outcomes for children are assessed at 12-14 weeks (i.e., corresponding with the end of TF-CBT), 6-months post-treatment, and 12-months post-treatment. TF-CBT experts from our team partner with the lay counselors from the feasibility study (e.g., local trainers) to train the TZ ad KE counselors, and these local trainers provide the TF- CBT supervision, while supervised themselves by the US-based TF-CBT and mental health experts. We expect this trial to yield recommendations regarding an effective intervention for orphans that is acceptable, feasible, and includes local responsibility as a means to enhance potential sustainability in LAMICs. Findings will inform other efforts to scale up mental health interventions to address the substantial mental health gap.