SYV: A Mental Health Intervention to Improve HIV Outcomes in Tanzanian Youth

SYV：改善坦桑尼亚青年艾滋病毒感染结果的心理健康干预措施

基本信息

批准号：
10160486
负责人：
Dorothy E. Dow
金额：
$ 54.62万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2026-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10160486
关键词：
Acquired Immunodeficiency Syndrome Address Adherence Adolescence Adolescent Adult Africa African Age Age-Years Anti-Retroviral Agents Behavioral Caregiver support Caregivers Caring Child Chronic Disease Clinic Clinical Trials Cognitive Therapy Complex Consolidated Framework for Implementation Research Data Development Disclosure Disease Disease Outcome Dose Effect Modifiers (Epidemiology)Effectiveness Emotional Epidemic Equation Evidence based intervention Failure Feedback Formulation Foundations Goals HIV HIV Infections Hair Health Health Professional Health Services Research Hybrids Incidence Individual Infection Informal Social Control Intervention Interview Investments Joints Lead Learning Life Logic Measurement Measures Mediating Mediator of activation protein Medicine Mental Health Mental Health Services Methods Modeling Morbidity - disease rate Outcome Participant Patient Self-Report Persons Pharmaceutical Preparations Pilot Projects Policies Population Positioning Attribute Productivity Public Health RNA Randomized Regulation Reproductive Health Research Research Priority Resources Risk Sampling Severities Site Social support Societies Stigmatization Stress Structure Symptoms Tanzania Testing Time Training Trauma United States National Institutes of Health Validation Viral Voice Work Youth acceptability and feasibility age group antiretroviral therapy base comorbidity coping cost cost effectiveness cost-effectiveness ratio design effectiveness evaluation effectiveness implementation trial evidence base experience follow-up high risk population hybrid type 1 design implementation determinants implementation outcomes improved incremental cost-effectiveness innovation interpersonal therapy intervention effect medication compliance meetings mortality motivational enhancement therapy multidisciplinary novel novel strategies peer physical conditioning pill population health prevent primary outcome resilience sex skills social social stigma standard of care success therapy adherence therapy design transmission process treatment arm treatment group trend trial design virology young adult

项目摘要

Young people living with HIV (YPLWH, 10-24 years of age) are a growing population that experience unique mental health challenges that may compromise their HIV care. Despite the clear need, few evidence-based mental health interventions exist to address the difficulties faced by this important population. The long-term goal of our research is to provide developmentally appropriate, evidence-based mental health interventions that effectively prevent and treat HIV in young people, especially in low resource settings where the majority of the epidemic occurs. Sauti ya Vijana (SYV, The Voice of Youth), is a novel and innovative group-based mental health and life skills intervention designed with and for Tanzanian YPLWH to address the mental health and life challenges they have described in our prior research. The intervention consists of 10 group sessions (two joint with caregivers) and two individual sessions delivered by trained young adults living with HIV who have successfully transitioned to the adult clinic using a task sharing model that builds local capacity while overcoming the critical shortage of mental health professionals in this setting. SYV incorporates components of Trauma Informed-Cognitive Behavioral Therapy, Interpersonal Psychotherapy, and Motivational Interviewing that during this critical neurodevelopmental period, when foundations of self and social regulation are realized, may prevent or dramatically reduce severity of mental health symptoms. The overall objectives of this proposal are to support positive coping strategies that bolster mental health and lead to improved HIV outcomes among YPLWH. The central hypothesis is that SYV will be effective to improve antiretroviral therapy (ART) adherence and virologic suppression in YPLWH in Tanzania. The rationale for this project is that by targeting mental health, which is strongly associated with medication adherence, we will effectively improve adherence and thereby HIV viral suppression. The central hypothesis will be tested in three aims in a hybrid type-1 effectiveness-implementation trial. The first aim will use an individually randomized group treatment trial design to determine if SYV is effective based on the primary outcome of 10% increase in virologic suppression (HIV RNA <400 copies/mL) among YPLWH in the intervention arm compared to standard of care. The second aim will elucidate the mechanisms by which SYV works and for whom it is most effective by evaluating potential moderators and mediators of the intervention using structure equation modelling. Change in mental health, internal stigma, resilience and coping are hypothesized to mediate the intervention effect, while age, sex, site, and baseline mental health symptoms are hypothesized moderators. The final aim will evaluate implementation determinants and outcomes, including cost effectiveness and sustainability guided by the Consolidated Framework for Implementation Research (CFIR) to identify any implementation differences among sites. This project is significant because it is expected to fill a critical mental health gap in caring for YPLWH in low resource settings with far-reaching implications on individual health (HIV suppression) and population health (preventing transmission of HIV infection to others).

感染艾滋病毒的年轻人（YPLWH，10-24 岁）是一个不断增长的群体，他们经历着独特的心理健康挑战可能会影响他们的艾滋病毒护理。尽管有明确的需求，但很少有基于证据的心理健康干预措施的存在就是为了解决这一重要人群所面临的困难。长期来看我们研究的目标是提供适合发育的、基于证据的心理健康干预措施有效预防和治疗年轻人中的艾滋病毒，特别是在资源匮乏的环境中，其中大多数人流行病发生。 Sauti ya Vijana（SYV，青年之声）是一种新颖且创新的基于群体的心理与坦桑尼亚 YPLWH 一起设计并为其设计的健康和生活技能干预措施，以解决心理健康和生活问题他们在我们之前的研究中描述了挑战。干预措施包括 10 次小组会议（两次联合与护理人员）以及由经过培训的感染艾滋病毒的年轻人提供的两次单独课程使用任务共享模型成功过渡到成人诊所，该模型在克服困难的同时建立了当地能力在这种情况下，心理健康专业人员严重短缺。 SYV 包含 Trauma 的组件知情认知行为治疗、人际心理治疗和动机访谈在这个关键的神经发育时期，当自我和社会调节的基础得以实现时，可能会阻止或显着减轻心理健康症状的严重程度。该提案的总体目标是支持积极的应对策略，可促进 YPLWH 的心理健康并改善艾滋病毒结果。这中心假设是 SYV 将有效提高抗逆转录病毒治疗 (ART) 依从性和病毒学检测坦桑尼亚 YPLWH 的镇压。该项目的基本原理是通过针对心理健康，即与药物依从性密切相关，我们将有效提高依从性，从而提高艾滋病病毒感染率抑制。中心假设将在混合 1 型有效性实施中的三个目标中进行检验审判。第一个目标将使用单独随机分组治疗试验设计来确定 SYV 是否有效基于病毒学抑制增加 10%（HIV RNA <400 拷贝/mL）的主要结果干预组中的 YPLWH 与标准护理相比。第二个目标将阐明机制通过评估 SYV 的潜在调节者和调解者，SYV 的工作方式以及对谁最有效使用结构方程模型进行干预。心理健康、内部耻辱、复原力和应对方式的变化假设介导干预效果，而年龄、性别、地点和基线心理健康症状是假设的调节者。最终目标将评估实施决定因素和结果，包括以实施研究综合框架为指导的成本效益和可持续性 (CFIR) 以确定站点之间的任何实施差异。这个项目意义重大，因为它预计填补资源匮乏地区照顾 YPLWH 方面的关键心理健康空白，对个人健康（抑制艾滋病毒）和人口健康（防止艾滋病毒感染传播给他人）。