Our Family Our Future: A resilience-oriented family intervention to prevent adolescent HIV/STI infection and depression in South Africa

我们的家庭我们的未来：以复原力为导向的家庭干预措施，以预防南非青少年艾滋病毒/性传播感染和抑郁症

• 批准号: 10222523
• 负责人: Linda-Gail Gail Bekker
• 金额: $ 59.8万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-11 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222523
• 关键词: 14 year old; 16 year old; AIDS prevention; Address; Adherence; Adolescence; Adolescent; Affect; Age; Attitude; Behavior; Behavioral; Biological Factors; Communication; Communities; Country; Data; Development; Dissemination and Implementation; Distress; Elements; Emotions; Ensure; Environment; Environmental Risk Factor; Epidemic; Epidemiology; Exhibits; Face; Family; Future; Future Generations; Gender; Goals; Government; Grant; HIV; HIV Infections; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Interview; Knowledge; Language; Life; Life Cycle Stages; Link; Major Depressive Disorder; Manuals; Mediating; Mental Depression; Mental Health; Motivation; National Institute of Allergy and Infectious Disease; National Institute of Child Health and Human Development; National Institute of Mental Health; Numbness; Outcome; Outcome Assessment; Parents; Phase; Population; Poverty; Predisposition; Prevalence; Prevention; Prevention approach; Process; Public Health; Randomized; Reporting; Research; Research Priority; Resources; Risk; Risk Behaviors; Risk Factors; STI prevention; Science; Self Efficacy; Severities; Sexual Health; Sexually Transmitted Diseases; Social Protection; South Africa; South African; Standardization; Structure; United States National Institutes of Health; Unsafe Sex; Violence; acceptability and feasibility; adolescent HIV prevention; adolescent health; base; child depression; community engaged research; community setting; condoms; depressive symptoms; design; efficacious intervention; efficacy study; efficacy testing; efficacy trial; emotion dysregulation; emotional experience; experience; family support; food insecurity; habituation; improved; literacy; pilot trial; prevent; preventive intervention; programs; protective behavior; protective efficacy; protective factors; psychological distress; randomized trial; reduce symptoms; resilience; scale up; selective prevention; sex; sexual HIV transmission; sexual risk behavior; skills; social structure; sociodemographics; substance use; treatment as usual

PROJECT SUMMARY/ABSTRACT Adolescent human immunodeficiency virus (HIV) and depression present significant public health challenges for South Africa, a country with the largest HIV epidemic globally and where structural factors including vio- lence and poverty increase susceptibility for poor mental health. In families already experiencing psychological distress, adolescents face elevated risk for sexually transmitted infections (STIs) including HIV and depres- sion. Preventive interventions are urgently needed during adolescence when risks for HIV, STIs, and depres- sion in-crease exponentially. Preventive intervention strategies for adolescents should substantively involve families who can tailor prevention content to meet the unique needs of individual adolescents and reinforce formation and habituation of prevention behaviors. Moreover, evidence indicates common family risk and pro- tective factors for adolescent HIV/STI risk behaviors and depression, underscoring the need for a family pre- vention approach. However, key gaps exist in family prevention science. In South Africa, few empirically sup- ported family interventions integrate prevention of HIV/STI with depression for adolescents. Our resilience-ori- ented approach engages families in adolescent prevention from low-resource settings facing high adversity. We focus on adolescents (14-16 years of age) who are at an ideal developmental transition for family engage- ment in prevention. Our age- and developmentally-tailored intervention – called Our Family Our Future – is based off of two empirically supported interventions that have been integrated and adapted to South Africa. In a pilot randomized trial, Our Family Our Future exhibited outstanding acceptability, feasibility and promising direction of effects including reductions of depressive symptoms; lower rates of sex; decreased unprotected sex; increased HIV testing; increased knowledge, motivation, intentions and self-efficacy for protective HIV/STI behaviors; improved family interactions; and increased resilience. Now we propose the next phase of this re- search program, an efficacy study of Our Family Our Future with three aims: (1) test the efficacy of the Our Family Our Future intervention in preventing HIV/STI acquisition among adolescents (14-16 years of age) with depressive symptoms by reducing HIV/STI risk behavior, and reducing depressive symptoms. The project will randomize N=880 adolescents to Our Family Our Future intervention or usual care with 6- and 12-month out- come assessments; (2) examine the extent to which the impact of the Our Family Our Future intervention is a) mediated by changes in resilience; behavioral skills; norms and attitudes relating to sex, condom use, gender; and family communication and functioning and b) moderated by the effect of sociodemographics, family HIV, and social protections; (3) identify barriers and facilitators to implementing Our Family Our Future within a large community-based organization setting with wide reach to provide data for future dissemination and scale-up. The study fills a significant gap in family prevention science in a priority population and setting and is aligned with the Trans-NIH Plan for HIV, NIMH, NIAID, and NICHD strategic research priorities.

项目概要/摘要 青少年人类免疫缺陷病毒（HIV）和抑郁症给公共卫生带来了重大挑战 对于南非来说，这个国家是全球艾滋病毒流行最严重的国家，其结构性因素包括暴力 贫困并增加已经经历心理健康问题的家庭的易感性。 青少年面临着包括艾滋病毒在内的性传播感染 (STI) 和抑郁症的更高风险 当青春期面临艾滋病毒、性传播感染和抑郁症风险时，迫切需要采取预防性干预措施。 青少年的预防性干预策略应实质性地增加。 家庭可以定制预防内容，以满足青少年个体的独特需求，并加强 此外，有证据表明，预防行为的形成和习惯是常见的家庭风险和亲。 青少年艾滋病毒/性传播感染危险行为和抑郁症的保护因素，强调家庭预防的必要性 然而，南非的家庭预防科学存在重大差距，很少有实证支持。 移植的家庭干预措施将艾滋病毒/性传播感染的预防与青少年抑郁症结合起来。 积极的方法让家庭参与到资源匮乏、面临高度逆境的青少年预防工作中。 我们专注于处于家庭参与理想发展过渡阶段的青少年（14-16 岁） 我们针对年龄和发展量身定制的干预措施——称为“我们的家庭，我们的未来”——是 基于两项经经验支持的干预措施，这些干预措施已被整合并适应南非。 《我们的家庭，我们的未来》是一项随机试点试验，显示出出色的可接受性、可行性和前景 影响的方向，包括减少抑郁症状；降低无保护性行为的发生率； 性；增加艾滋病毒检测；增加预防性艾滋病毒/性传播感染的知识、动机、意图和自我效能 行为；改善家庭互动；以及增强复原力。 搜索计划，一项“我们的家庭，我们的未来”的功效研究，其三个目标是：（1）测试“我们的家庭，我们的未来”的功效 “家庭我们的未来”干预措施预防青少年（14-16 岁）感染艾滋病毒/性传播感染 该项目将通过减少艾滋病毒/性传播感染风险行为来减轻抑郁症状。 将 N=880 名青少年随机分配到我们的家庭、我们的未来干预或常规护理中，为期 6 个月和 12 个月 (2) 检查“我们的家庭，我们的未来”干预措施的影响程度 a) 通过与性、安全套使用、性别相关的行为技能的变化来调节； 和家庭沟通和功能，b) 受到社会人口统计学、家庭艾滋病毒、 (3) 找出在一定范围内实施“我们的家庭，我们的未来”的障碍和促进因素 大型社区组织环境，影响范围广泛，为未来的传播和提供数据 该研究填补了优先人群和环境中家庭预防科学的重大空白。 与跨 NIH 计划的 HIV、NIMH、NIAID 和 NICHD 战略研究重点保持一致。