Shaping the Health of Adolescents in Zimbabwe (SHAZ!)

描述（由申请人提供）：津巴布韦正面临艾滋病毒普遍流行和经济迅速衰退的协同灾难。这两个因素造成了大量的孤儿和弱势儿童（OVC）， 2007年估计有150万。青少年女性的受教育和经济机会有限，感染艾滋病毒的可能性是同龄男性的两倍，从事高风险性行为的可能性比非青少年女性高。在艾滋病毒感染者中，经济脆弱性以及贫穷和艾滋病毒阳性的心理后果增加了二次传播和难以获得护理的风险。在这一弱势群体中，显然需要解决二级预防问题（艾滋病毒传播和与艾滋病毒相关的心理疾病）；然而，现有的行为干预措施可能影响有限，因为它们没有解决影响行为的基本经济因素。制定和评估解决这些因素的结构性干预措施至关重要。通过本次延续提案，我们提议扩大SHAZ！（塑造津巴布韦青少年健康）——一项预防艾滋病毒的干预措施，通过改善经济机会，并将她们与基于生活技能的艾滋病毒教育和对艾滋病毒阳性参与者的临床护理联系起来，使女性青少年有能力避免性风险行为。在纳入SHAZ的20名艾滋病毒阳性参与者的试点工作基础上！在此，我们建议对“SHAZ!”在另外650名艾滋病毒阳性参与者中，所有人都将与临床护理联系起来，然后随机分配到经济（职业培训、指导咨询和小额赠款）和生活技能联合干预，而不是单独的生活技能干预。在主要研究正在进行时（目标于2009年初完成）启动这一扩展，将使我们能够在现有基础设施的基础上进行建设，从而节省大量成本，并隐瞒研究参与者的艾滋病毒状况，促进我们的道德使命，确保保密。通过我们提出的设计，我们将评估SHAZ的效果，该设计汇集了RTI国际组织的全球妇女健康倡议、津巴布韦大学ucsf研究项目、泛大陆全球艾滋病基金会和Chitungwiza医院的艾滋病毒/艾滋病诊所。(1)经济生计和社会资源指标；(2)坚持护理和治疗，以及随后的健康结果；(3)心理疾病、信息披露和应对技能；(4)与HIV继发传播相关的行为，以及（4.a）继发传播风险行为是否受治疗结果或社会心理因素的调节。如果这个创新的SHAZ！如果positive模型被证明是有效的，这些发现将对该地区乃至其他地区的规划和政策产生深远的影响。公共卫生相关性：该项目(SHAZ！-Plus)旨在促进高度脆弱人群的二级预防（艾滋病毒传播和与艾滋病毒相关的心理疾病）：生活在津巴布韦的艾滋病毒阳性的青春期女孤儿。通过解决这一群体潜在的经济和社会脆弱性，SHAZ！-Plus有潜力促进二级预防，而不仅仅是行为干预可能产生的有限影响。如果这种创新模式被证明是有效的，这些发现将对该地区及其他地区的项目规划和政策产生深远影响。

DESCRIPTION (provided by applicant): Zimbabwe is confronting the synergistic plagues of a generalized HIV epidemic and rapid economic decline. Both have contributed to the large number of orphans and vulnerable children (OVC) estimated at 1.5 million in 2007. Adolescent female OVC have limited access to educational and economic opportunities, are twice as likely to be HIV infected than their male counterparts, and are more likely than non-OVC to engage in high-risk sexual behavior. Among those that are HIV infected, economic vulnerability and the psychological consequences of being poor and HIV positive, increase the risk of secondary transmission and poor access to care. There is a clear need to address secondary prevention (of HIV transmission and of HIV- related psychological morbidity) in this vulnerable population; however, existing behavioral interventions are likely to have limited impact in that they do not address the fundamental economic factors conditioning behavior. It is critical that structural interventions that do address such factors be developed and evaluated. Through this continuation proposal, we propose to expand SHAZ! (Shaping the Health of Adolescents in Zimbabwe)-an HIV prevention intervention that empowers adolescent female OVC to avoid sexual risk behaviors by improving economic opportunities and linking them to life skills-based HIV education and clinical care-to HIV-positive participants. Building on pilot work among 20 HIV-positive participants integrated into the SHAZ! study, here we propose to conduct a full study of "SHAZ! for Positives" among 650 additional HIV-positive participants, all of whom will be linked to clinical care and then randomly assigned to the combined economic (vocational training, guidance counseling, and a micro-grant) and life skills intervention compared to the life skills intervention alone. Initiating this expansion while the main study is ongoing (targeted for completion in early 2009) will enable us to build on our existing infrastructure and, thus, effect substantial cost savings, as well as conceal the HIV status of study participants, facilitating our ethical mandate to ensure confidentiality. Through our proposed design-that brings together the Women's Global Health Imperative at RTI International, the University of Zimbabwe-UCSF Research Programme, the Pangaea Global AIDS Foundation and the HIV/AIDS clinic at the Chitungwiza Hosptial-we will evaluate the effect of SHAZ! for Positives on: (1) indicators of economic livelihoods and social resources; (2) adherence to care and treatment, and subsequent health outcomes; (3) psychosocial morbidity, disclosure, and coping skills; (4) behaviors associated with the secondary transmission of HIV, and (4.a) whether secondary transmission risk behavior is mediated by treatment outcomes or psychosocial factors. If this innovative SHAZ! for Positives model is proven effective, these findings will have far-reaching program and policy implications in the region and beyond. PUBLIC HEALTH RELEVANCE: This project (SHAZ!-Plus) aims to promote secondary prevention (of HIV transmission and of HIV-related psychological morbidity) among a highly vulnerable population: HIV-positive adolescent female orphans living in Zimbabwe. By addressing the underlying economic and social vulnerability of this population, SHAZ!-Plus has the potential to promote secondary prevention beyond the limited impact behavioral interventions are likely to have alone. If this innovative model is proven effective, these findings will have far-reaching implications for program planning and policy in the region and beyond.