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，许多艾滋病毒感染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过渡的影响是未知的。这项拟议的研究是我们目前NIMH资助的R 01资助HIV+青少年和血清逆转者的心理健康和风险行为（R 01 MH 069133; PI：Mellins）的竞争性延续，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）的青年以及基线（9-16岁的青年）和18个月随访（11-18岁的青年）的数据的最后一年。参与者最初是从纽约市的四个城市医疗中心招募的。在拟议的项目中，CASAH-2，我们将研究艾滋病毒感染对风险和适应行为的影响，作为我们脆弱的青年接近和过渡到年轻的成年人的样本。我们将研究艾滋病毒感染和关键的风险和保护因素，从我们的健康行为的理论模型，社会行动理论，影响行为的结果，可能会破坏或增强成人功能。在CASAH-2中，青年和照顾者将在CASAH-1后续访谈后1-3年重新招募。他们将在CASAH-2的另外三个随访时间点接受访谈，每隔一年，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，以及受感染青年的医疗保健结果）以及影响行为健康结果的风险和保护因素。在CASAH-2中，我们将纳入与向青春期老年人和青年人过渡特别相关的变量（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HIV+青年，向成人HIV医疗护理的过渡）。很少有围产期艾滋病毒感染的行为研究集中在心理社会变量，也没有跟随青年进入这个年龄范围，很少有足够的比较组，以确定风险和适应行为的相关性，独特的围产期感染的青年在不同的发展阶段的青少年和年轻的成年。这类研究将对美国以及资源匮乏国家中规模大得多的儿科艾滋病流行产生重要的干预影响，直到最近，这些国家获得抗逆转录病毒治疗的机会有限，导致数百万围产期感染儿童。公共卫生相关性：在长期可获得抗逆转录病毒治疗的国家，相对较多的围产期感染青年现在才开始进入青春期和青年期。关于艾滋病毒所带来的发展挑战以及阻碍或促进这些青年在接近青年期时最佳发展的因素的研究很少。这项拟议中的研究将是第一个研究艾滋病毒流行病随着时间的推移对青年人作为成年人适应和为社区作出贡献的能力的影响，或者相反，由于高风险行为而构成公共卫生挑战的研究。研究结果将使我们能够为快速成为美国健康状况不佳和行为结果的新风险群体的人群提供有效的教育，治疗和预防干预措施奠定基础。此外，非洲、拉丁美洲和亚洲的孕产妇艾滋病毒疫情有增无减，感染艾滋病毒和“受艾滋病毒影响”的儿童人数惊人，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.