Intergenerational Intervention: Employing Youth to Promote Aging Healthy with HIV in Rural South Africa

项目概要： 南非迅速增长的老年艾滋病毒感染者（OPLHV）的艾滋病毒相关结果并不理想，因为他们面临着残疾和慢性疾病水平的同时上升，以及缺乏明确针对老年人的艾滋病毒护理和治疗干预措施。由于家庭护理的替代方案很少，大多数非洲老年人都在原地养老，但随着“空心化”的中间一代和高劳动力迁移率，有必要寻找其他地方，以寻求健康老龄化所需的多方面支持。拟议的项目旨在探讨创新的代际干预措施如何改善艾滋病毒和艾滋病感染者中相关并发症的管理方法，同时为青年失业是全国关注的问题的南非年轻一代提供机会，雇用青年在其社区协助艾滋病毒感染者。为了塑造早期干预发展，拟议的形成性和顺序混合方法研究旨在：1）确定社会支持的决定因素与健康老龄化与艾滋病毒的性别和整个晚年的生活过程，包括ART管理，多病管理，和生活满意度，以及如何支持是由家庭结构和组成调节，通过对美国国立卫生研究院资助的研究《非洲的健康与老龄化：INDEPTH社区的纵向研究》中现有定量数据的纵向分析; 2）阐明如何在代际上战略性地填补社会支持差距，并为可行的干预措施提供信息。这一目标将通过与关键干预利益攸关方的定性数据来实现，包括a）与老年人及其家庭成员的深入访谈; B）与社区关键信息提供者的半结构化访谈;以及c）与青年的焦点小组讨论。该项目响应需要准备越来越多的成年人老龄化与艾滋病毒和相关的合并症，同时增加证据基础，以支持在不同的环境和亚群OPLHV干预措施的设计。

PROJECT SUMMARY: South Africa’s rapidly growing population of older adults living with HIV (OPLHV) have suboptimal HIV-related outcomes, as they face a concomitant rise in levels of disability and chronic disease on top of a lack of HIV care and treatment interventions explicitly targeting older populations. With few alternatives to family-based care, most older Africans age in place, but with the “hollowed out” middle generation and high rates of labor migration, there is need to look elsewhere to seek the multi-dimensional support needed to age healthily. The proposed project aims to explore how an innovative intergenerational intervention could improve approaches to the management of HIV and related co-morbidities among OPLHV while offering opportunity to the younger generation in South Africa, where youth unemployment is a national concern, by employing youth to assist OPLHV in their communities. To shape early intervention development, the proposed formative and sequential mixed methods study aims to: 1) Identify the determinants of social support associated with aging healthy with HIV by gender and across the later life course—including ART management, management of multimorbidities, and life satisfaction—and how that support is moderated by household structure and composition, through longitudinal analysis of existing quantitative data from the NIH-funded study, Health and Aging in Africa: Longitudinal Studies of an INDEPTH Community; and 2) Elucidate how social support gaps can be strategically filled intergenerationally and inform a feasible intervention. This aim will be met using qualitative data with key intervention stakeholders, including a) in-depth interviews with older adults and their household member(s); b) semi-structured interviews with key informants from the community; and c) focus group discussions with youth. This project responds to the need to prepare for the growing population of adults aging with HIV and related co-morbidities while increasing the evidence base to support the design of interventions for OPLHV in diverse settings and subpopulations.