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

描述（由申请人提供）：改善孤儿青年的成果：实施以创伤为中心的认知行为疗法（Trauma-focused CBT）本R 01提案的主要目标是研究以创伤为中心的认知行为疗法（TF-CBT）在治疗艾滋病毒高流行率的两个东非地区（坦桑尼亚莫希和肯尼亚邦戈马）的孤儿和青少年的创伤性悲伤和创伤性压力方面的有效性。随机对照试验（RCT）。低收入和中等收入国家（LAMIC）的心理健康差距很大，需要治疗的人很少得到基本护理。目前，全世界有1.43亿孤儿和青少年，仅撒哈拉以南非洲就有近5 000万，其中1 660万是艾滋病毒/艾滋病造成的。这些儿童是弱势儿童，他们在父母死亡后往往有心理健康问题，而且创伤暴露率很高。在我们对坦桑尼亚孤儿进行TF-CBT的可行性研究中，我们发现基于组的TF-CBT干预是可行和可接受的，具有良好的临床效果。在可行性研究中，没有心理健康经验的非专业顾问在我们的心理健康和TF-CBT专家团队的培训和监督下进行干预。 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对创伤性悲伤和创伤性应激的有效性，与TZ和KE接受常规护理孤儿服务相比。该研究从三个方面扩展了我们之前的工作：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; 3）涉及与可行性研究中经验丰富的非专业顾问合作，以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性。拟议的研究涉及与艾滋病毒/艾滋病基层组织和TZ和KE的当地合作研究者的合作，他们都是我们美国团队的长期合作者，位于城乡混合地区，允许在两个国家和两种环境（城市/农村）中检查有效性。使用任务转移的方法，其中非专业人员被培训为咨询师，我们将在每个国家培训9名咨询师，他们在每个地点提供20个小组（10个农村，10个城市），导致320名儿童和青少年（7-13岁）接受TF-CBT，320名接受常规护理。在12-14周时评估儿童的结局（即，对应于TF-CBT结束）、治疗后6个月和治疗后12个月。来自我们团队的TF-CBT专家与来自可行性研究的非专业顾问合作（例如，当地培训师）培训TZ和KE辅导员，这些当地培训师提供TF-CBT监督，同时由美国TF-CBT和心理健康专家监督自己。我们希望这项试验产生的建议，对孤儿的有效干预是可以接受的，可行的，并包括当地的责任，作为一种手段，以提高潜在的可持续性LAMIC。调查结果将为其他努力提供信息，以扩大心理健康干预措施，以解决巨大的心理健康差距。

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.