Mental Health and Risk in HIV+ Youth and Seroreverters

描述（由申请人提供）：拟议的五年研究的目标是：1)确定围产期感染艾滋病毒的青少年中精神疾病和行为健康结果的患病率，包括情绪和行为功能、艾滋病毒风险行为和药物依从性；2)通过比较围产期艾滋病毒感染青年和未感染青年在子宫内暴露于艾滋病毒（血清逆转者）来检验艾滋病毒感染与精神疾病和行为健康结局之间的关系；3)确定两组在未来18个月内与行为健康结果相关的风险和保护因素。为了实现研究目标，我们将对居住在纽约市的200名围产期艾滋病毒感染儿童和150名9 - 16岁的血清逆转者进行为期五年的纵向研究，纽约市是美国妇女和儿童艾滋病毒流行的中心之一。建议的700名参与者的样本将由儿童（n = 350）和他/她的主要照顾者（n = 350）组成。将使用两种数据来源：1)照顾者和儿童访谈；2)医疗图表提取（淋巴细胞亚群、HIV RNA病毒载量、CDC诊断、抗逆转录病毒治疗、医疗服务利用）。每位参与者将在基线和18个月的随访期间接受单独访谈。在社会行动理论的指导下，访谈将评估精神疾病、行为健康结果以及一系列行为健康结果的决定因素。这些决定因素包括个人的自我调节过程和更大的社会、家庭、个人和环境背景。在本研究中，我们强调儿童的HIV状况和精神功能以及家庭因素（沟通、监督和参与）在影响行为健康结果中的重要性。参与者将从纽约市的四个主要医疗中心招募，每个医疗中心都为感染艾滋病毒的儿童和血清逆转者提供全面的医疗和心理保健。这些诊所的病人主要是非裔美国人和拉丁裔人，他们生活在市中心社区的贫困中，艾滋病毒血清感染率和吸毒率都很高，这反映了儿童艾滋病毒的流行。拟议的研究将告诉我们具体的压力源和心理健康问题的相关性，以及这一人群的艾滋病毒风险行为。因此，这将是开发有效干预措施的关键一步，在美国和发展中国家，这一人群正在迅速成为一个新的风险群体，“获得治疗和其他资源有限”。

DESCRIPTION (provided by applicant): The goals of the proposed five year study are to 1) determine the prevalence of Psychiatric Disorders and Behavioral Health Outcomes, including emotional and behavioral functioning, HIV risk behaviors, and adherence to medication in perinatally HIV-infected adolescents; 2) examine the association between HIV infection and Psychiatric Disorders and Behavioral Health Outcomes by comparing perinatally HIV-infected youth to uninfected youth exposed to HIV in utero (seroreverters); and 3) identify risk and protective factors related to Behavioral Health Outcomes in both groups prospectively over 18 months. To achieve the study goals, we will conduct a five year, longitudinal study of 200 perinatally HIV-infected children and 150 seroreverters, ages 9 - 16 years, residing in NYC, one of the epicenters of the HIV epidemic among women and children in the US. The proposed sample of 700 participants will consist of the child (n = 350) and his/her primary caregiver (n = 350). Two sources of data will be used: 1) caregiver and child interviews and 2) medical chart abstraction (lymphocyte subsets, HIV RNA viral load, CDC diagnosis, antiretroviral treatment, medical service utilization). Each participant will be individually interviewed at baseline and 18-month follow-up. The interview, guided by Social Action Theory, will assess Psychiatric Disorders, Behavioral Health Outcomes, and a range of determinants of Behavioral Health Outcomes. These determinants consist of the individual's self-regulation processes and the larger social, family, individual, and environmental context. In the proposed study, we emphasize the importance of the child's HIV status and psychiatric functioning as well as family factors (communication, supervision, and involvement) in influencing Behavioral Health Outcomes. Participants will be recruited from four major medical centers in NYC, each of which provides comprehensive medical and mental health care to HIV-infected children and seroreverters. Reflecting the pediatric HIV epidemic, the patients in these clinics are primarily African American and Latino, living in poverty in inner-city communities, with high HIV seroprevalence and rates of drug use. The proposed study will inform us about the specific stressors and correlates of mental health problems, as well as HIV risk behavior in this population. Thus, it will be a critical step in the development of effective interventions for a population that is fast emerging as a new risk group both in the US and in developing countries with 'limited access to treatment and other resources.