Transitioning from childhood to adulthood: the impact of perinatal HIV infection

描述（由申请人提供）：随着抗逆转录病毒治疗（ART）的出现，许多感染艾滋病毒的儿童正在进入青春期和青年期。然而，围产期艾滋病毒感染对从青春期到青年期的关键发育转变的影响尚不清楚。拟议的研究是我们目前NIMH资助的R01资助的HIV+青年和血清转复者的心理健康和风险行为（R01MH069133; PI:Mellins）的竞争延续，非正式地称为CASAH-1（儿童和青少年自我意识和健康）。在CASAH-1中，我们正处于收集围产期艾滋病毒感染和围产期艾滋病毒暴露但未感染（血清逆转）的青少年及其护理人员基线（9-16岁青少年）和18个月随访（11-18岁青少年）数据的最后一年。参与者最初是从纽约市的四个城市医疗中心招募的。在拟议的CASAH-2项目中，我们将研究艾滋病毒感染对风险和适应行为的影响，作为弱势青年接近和过渡到青年成年期的样本。我们将从我们的健康行为理论模型，社会行动理论，研究艾滋病毒感染和关键风险和保护因素如何影响可能破坏或增强成人功能的行为结果。在CASAH-2中，青少年和护理人员将在他们的CASAH-1随访访谈后1-3年重新招募。他们将在CASAH-2中另外三个随访时间点接受访谈，每次间隔一年，在CASAH-1和CASAH-2中共进行五次访谈。访谈评估行为健康结果（包括情绪和行为功能，性和药物使用行为，以及受感染青年的卫生保健结果）以及影响行为健康结果的风险和保护因素。在CASAH-2中，我们将包括与过渡到青春期和青年期特别相关的变量（例如，与学校/职业、社会关系、亲社会行为和自主性相关的功能里程碑，以及对于艾滋病毒阳性青年，过渡到成人艾滋病毒医疗护理）。很少有关于围产期艾滋病毒感染的行为研究侧重于社会心理变量，也没有将青年跟踪到这个更大的年龄范围，很少有足够的比较组来确定在青少年和青年成年的不同发育阶段围产期感染青年特有的风险和适应行为的相关性。这样的研究将对美国具有重要的干预意义，也对资源匮乏国家更大的儿童艾滋病毒流行具有重要意义，直到最近，这些国家获得抗逆转录病毒治疗的机会有限，导致数百万围产期儿童感染。公共卫生相关性：在长期可获得抗逆转录病毒治疗的国家，受围产期感染的青年现在才开始进入青春期和青年期，人数相对较多。关于艾滋病毒带来的发展挑战以及阻碍或促进这些青年进入青年期的最佳发展的因素的研究很少。拟议的研究将是同类研究中第一个研究艾滋病毒流行病随着时间的推移对青年成年后适应和为社区做出贡献的能力的影响，或者相反，由于高风险行为而对公共卫生构成挑战的影响。研究结果将使我们能够为有效的教育、治疗和预防干预奠定基础，针对美国快速出现的健康状况不佳和行为结果的新风险群体。此外，在非洲、拉丁美洲和亚洲，感染艾滋病毒和“受艾滋病毒影响”的儿童人数惊人，孕产妇艾滋病毒的流行有增无减，迫切需要进行研究，以便为资源有限的国家的干预措施提供信息。

DESCRIPTION (provided by applicant): With the advent of antiretroviral treatment (ART), many HIV-infected children are reaching adolescence and young adulthood. However, the impact of perinatal HIV infection on the critical developmental transition from adolescence to young adulthood is unknown. The proposed study is a competing continuation of our current NIMH funded R01 grant Mental Health and Risk Behavior in HIV+ Youths and Seroreverters (R01MH069133; PI:Mellins), informally known as CASAH-1 (Child & Adolescent Self-Awareness and Health). In CASAH-1, we are in the final year of collecting data from perinatally HIV-infected and perinatally HIV-exposed, but uninfected (seroreverter) youth, as well as their caregivers at baseline (youth ages 9-16 years) and 18-month follow-up (youth ages 11-18 years). Participants were originally recruited from four urban medical centers in NYC. In the proposed project, CASAH-2, we will study the impact of HIV infection on risk and adaptive behaviors as our sample of vulnerable youth approach and transition into young adulthood. We will examine how HIV infection and critical risk and protective factors from our theoretical model of health behavior, Social Action Theory, affect behavioral outcomes that may disrupt or enhance adult functioning. In CASAH-2, youths and caregivers will be re-recruited 1-3 years after their CASAH-1 follow-up interview. They will be interviewed at three additional follow-up time points in CASAH-2, each one year apart for a total of five interviews across CASAH-1 and CASAH-2. The interview assesses Behavioral Health Outcomes (including emotional and behavioral functioning, sexual and drug use behavior, and for infected youth, health care outcomes) as well as risk and protective factors that influence the Behavioral Health Outcomes. In CASAH-2, we will include variables that are particularly relevant for the transition to older adolescence and young adulthood, (e.g. functional milestones related to school/vocation, social relationships, pro-social conduct, and autonomy, and for the HIV+ youth, transition to adult HIV medical care). Few behavioral studies of perinatal HIV infection have focused on psychosocial variables nor have they followed youth into this older age range, and few have adequate comparison groups to identify correlates of risk and adaptive behavior unique to perinatally-infected youth across different developmental stages of adolescents and young adulthood. Such research will have important intervention implications for the US, and also for the much larger pediatric HIV epidemic in low- resource countries where, until recently, limited access to ART has resulted in millions of perinatally infected children. PUBLIC HEALTH RELEVANCE: Perinatally-infected youths are only now beginning to enter older adolescence and young adulthood in relatively large numbers in countries with longstanding access to antiretroviral treatment. Few studies exist on the developmental challenges posed by HIV and the factors that impede or promote the optimum development of these youths as they approach young adulthood. The proposed study would be one of the first of its kind to examine the impact of the HIV epidemic over time on the youths' ability to adapt and contribute to their communities as adults or conversely to pose a public health challenge as the result of high risk behavior. Findings will allow us to lay the groundwork for effective educational, therapeutic, and preventive interventions for a population fast emerging as a new risk group for poor health and behavioral outcomes in the United States (US). Furthermore, the unabated maternal HIV epidemic in Africa, Latin America, and Asia, where the numbers of HIV-infected and "HIV-affected" children are staggering, urgently warrants studies that can inform interventions in countries with limited resources.