Suubi-Mhealth: A mobile health intervention to address depression and improve ART adherence among Youth living with HIV (YLHIV) in Uganda

项目摘要 2020年，约有170万15岁以下儿童感染艾滋病毒;大多数新感染艾滋病毒的儿童 (85%）发生在撒哈拉以南非洲（SSA）。艾滋病毒感染者（PLHIV）经常与心理健康作斗争 降低抗逆转录病毒治疗（ART）依从性的合并症。然而，撒南非洲76%至85%的艾滋病毒感染者 严重的精神疾病，尤其是抑郁症得不到治疗。抑郁减少ART 这对健康产生了负面影响，并增加了艾滋病毒传播的风险。大龄青少年（≥14岁） 艾滋病毒感染者特别容易受到这些风险的影响，因为照顾者在治疗期间退出或减少他们的支持。 他们向年轻人的过渡。此外，年龄较大的青少年也正在进入更大和更少的 艾滋病毒感染者的健康状况不佳，有可能退出抗逆转录病毒治疗方案。考虑到这种心理 撒南非洲包括乌干达的保健服务设备严重不足，许多艾滋病毒/艾滋病YLHIV感染者无法获得保健服务， 迫切需要新的解决方案，以增加获得精神保健的机会，缩小治疗差距。的 这项拟议的R21/33研究的总体目标是开发一种移动健康干预措施（Suubi-mhealth）， 乌干达青年（14-17岁）艾滋病毒和抑郁症共病，考虑到他们独特的背景， 文化和发展需求。通过移动的应用程序提供的数字治疗干预将 利用认知行为疗法（CBT）的核心原则来改善抑郁症和ART依从性。 本研究将具体包括：第1阶段。R21目标1：制定并反复完善干预措施 Suubi-Mhealth议定书，以了解艾滋病毒感染青年的需求为基础。我们 将举办四个青年焦点小组和两个卫生保健提供者焦点小组（每个小组6-8名青年）， 对干预内容和方法的反馈，以提高参与率和保留率。R21目标2：基于 目的1的结果，探讨其可行性和可接受性 随后对较大的R33相进行细化。相 小规模的Suubi-Mhealth（N=30），以告知 2.目标1：测试Suubi的初步影响， Mhealth与等待名单对照组（N=200）的青年结局（抑郁症、ART依从性、心理健康 功能、生活质量、耻辱）。R33目标2：审查整合Suubi-Mhealth的障碍和促进因素 为YLHIV提供医疗服务这项研究将在大马萨卡地区的10个诊所进行 在乌干达南部。我们希望Suubi-Mhealth成为一种可接受和可行的移动健康工具， 抑郁症，改善抗逆转录病毒疗法的坚持和整体心理健康功能之间的YLHIV。如果这件事的结果 试点是有希望的，那么下一步是R 01在更大的试验中严格测试Suubi-Mhealth， 乌干达的多个地点

PROJECT ABSTRACT Approximately 1.7 million children under 15 years old were living with HIV in 2020; and most new HIV infections (85%) occurred in Sub-Saharan Africa (SSA). People living with HIV (PLHIV) often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. However, 76% to 85% of PLHIV in SSA receive no treatment for serious mental health disorders, especially depression. Depression reduces ART adherence, which negatively impacts health and increases HIV transmission risks. Older adolescents (≥14 years) living with HIV are particularly vulnerable to these risks as caregivers withdraw or lessen their support during their transition to young adulthood. Moreover, older adolescents are also moving into larger and less accommodating adult HIV clinic settings and are at risk for dropping out of ART programs. Given that mental health services are severely under equipped in SSA, including in Uganda, and are inaccessible by many YLHIV, new solutions to increase access to mental health care and close the treatment gap are urgently needed. The overall goal of this proposed R21/33 study is to develop an mHealth intervention (Suubi-mhealth) for use among Ugandan youth (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. This digital therapy intervention delivered via a mobile application, will utilize the core tenets of cognitive-behavioral therapy (CBT) found to improve depression and ART adherence. The proposed study will specifically: Phase 1. R21 Aim 1: Develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand needs of youth living with HIV (YLHIV). We will conduct four focus groups with youth and two focus groups with health care providers (6-8 youth each) for feedback on intervention content and methods to increase participation and retention. R21 Aim 2: Based on results of Aim 1, explore the feasibility and acceptability subsequent refinement for the larger R33 phase. Phase of Suubi-Mhealth on a small scale (N=30), to inform 2. R33 Aim 1: Test the preliminary impact of Suubi- Mhealth versus a waitlist control group (N=200), on youth outcomes (depression, ART adherence, mental health functioning, quality of life, stigma). R33 Aim 2: Examine barriers and facilitators for integrating Suubi-Mhealth into health care settings for YLHIV. The study will be conducted in 10 health clinics in the greater Masaka region in Southern Uganda. We expect for Suubi-Mhealth to be an acceptable and feasible mHealth tool to reduce depression, improve ART adherence and overall mental health functioning among YLHIV. If the results of this pilot are promising, then the next step is an R01 to rigorously test Suubi-Mhealth in a larger trial, spanning multiple sites across Uganda.