Suubi-Mhealth: A mobile health intervention to address depression and improve ART adherence among Youth living with HIV (YLHIV) in Uganda

Suubi-Mhealth：一种移动健康干预措施，旨在解决乌干达艾滋病毒感染者 (YLHIV) 青少年的抑郁症问题并提高抗逆转录病毒疗法的依从性

• 批准号: 10526768
• 负责人: Patricia A Cavazos-Rehg
• 金额: $ 19.41万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-08 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10526768
• 关键词: 15 year old; Address; Adherence; Adolescent; Adult; Africa South of the Sahara; Age; Behavior Therapy; Car Phone; Caregivers; Child; Clinic; Clinical; Cognitive Therapy; Control Groups; Depressed mood; Development; Drops; Evaluation; Evidence based intervention; Feedback; Focus Groups; Goals; HIV; HIV Infections; Health; Health Personnel; Intervention; Interview; Lead; Letters; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methodology; Methods; Mobile Health Application; Outcome; Persons; Phase; Practical Robust Implementation and Sustainability Model; Prevalence; Protocols documentation; Public Health; Quality of life; Research; Resource-limited setting; Risk; Sampling; Signal Transduction; Site; Specific qualifier value; Structure; Subgroup; Testing; Therapeutic Intervention; Time; Uganda; United States National Institutes of Health; Waiting Lists; Work; Youth; acceptability and feasibility; active method; antiretroviral therapy; base; behavioral health; comorbidity; depressive symptoms; digital treatment; evidence base; experience; health care settings; improved; innovation; intervention effect; low and middle-income countries; mHealth; mobile application; pilot test; post intervention; primary outcome; programs; recruit; response; secondary outcome; social stigma; success; therapy adherence; tool; transmission process; treatment adherence; user centered design; young adult

PROJECT ABSTRACT Approximately 1.7 million children under 15 years old were living with HIV in 2020; and most new HIV infections (85%) occurred in Sub-Saharan Africa (SSA). People living with HIV (PLHIV) often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. However, 76% to 85% of PLHIV in SSA receive no treatment for serious mental health disorders, especially depression. Depression reduces ART adherence, which negatively impacts health and increases HIV transmission risks. Older adolescents (≥14 years) living with HIV are particularly vulnerable to these risks as caregivers withdraw or lessen their support during their transition to young adulthood. Moreover, older adolescents are also moving into larger and less accommodating adult HIV clinic settings and are at risk for dropping out of ART programs. Given that mental health services are severely under equipped in SSA, including in Uganda, and are inaccessible by many YLHIV, new solutions to increase access to mental health care and close the treatment gap are urgently needed. The overall goal of this proposed R21/33 study is to develop an mHealth intervention (Suubi-mhealth) for use among Ugandan youth (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. This digital therapy intervention delivered via a mobile application, will utilize the core tenets of cognitive-behavioral therapy (CBT) found to improve depression and ART adherence. The proposed study will specifically: Phase 1. R21 Aim 1: Develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand needs of youth living with HIV (YLHIV). We will conduct four focus groups with youth and two focus groups with health care providers (6-8 youth each) for feedback on intervention content and methods to increase participation and retention. R21 Aim 2: Based on results of Aim 1, explore the feasibility and acceptability subsequent refinement for the larger R33 phase. Phase of Suubi-Mhealth on a small scale (N=30), to inform 2. R33 Aim 1: Test the preliminary impact of Suubi- Mhealth versus a waitlist control group (N=200), on youth outcomes (depression, ART adherence, mental health functioning, quality of life, stigma). R33 Aim 2: Examine barriers and facilitators for integrating Suubi-Mhealth into health care settings for YLHIV. The study will be conducted in 10 health clinics in the greater Masaka region in Southern Uganda. We expect for Suubi-Mhealth to be an acceptable and feasible mHealth tool to reduce depression, improve ART adherence and overall mental health functioning among YLHIV. If the results of this pilot are promising, then the next step is an R01 to rigorously test Suubi-Mhealth in a larger trial, spanning multiple sites across Uganda.

项目摘要 2020 年，大约有 170 万 15 岁以下儿童感染艾滋病毒，并且大多数是新感染艾滋病毒的人； (85%) 发生在撒哈拉以南非洲地区 (SSA)，艾滋病毒感染者 (PLHIV) 经常面临心理健康问题。 然而，SSA 中 76% 至 85% 的 PLHIV 患者存在合并症。 没有接受严重精神健康障碍的治疗，尤其是抑郁症会降低 ART 的效果。 坚持，这会对健康产生负面影响并增加年龄较大青少年（≥14 岁）的艾滋病毒传播风险。 艾滋病毒感染者特别容易受到这些风险的影响，因为护理人员在感染期间撤回或减少支持。 此外，年龄较大的青少年也开始变得更大、更小。 适应成人艾滋病毒诊所环境，并且有退出 ART 计划的风险。 包括乌干达在内的撒哈拉以南非洲地区的卫生服务设施严重不足，许多 YLHIV 无法获得这些服务， 迫切需要新的解决方案来增加获得精神卫生保健的机会并缩小治疗差距。 这项拟议的 R21/33 研究的总体目标是开发一种移动健康干预措施 (Suubi-mhealth)，供以下人群使用： 考虑到他们独特的背景，患有艾滋病毒和抑郁症的乌干达青年（14-17 岁） 这种通过移动应用程序提供的数字治疗干预将满足文化和发展的需求。 利用认知行为疗法 (CBT) 的核心原则，发现可以改善抑郁症和 ART 依从性。 拟议的研究将具体： 第一阶段。R21 目标 1：开发并迭代完善干预措施 Suubi-Mhealth 协议基于了解艾滋病毒感染青少年 (YLHIV) 需求的形成性工作。 将举办 4 个青年焦点小组和 2 个医疗保健提供者焦点小组（每个 6-8 名青年），以 R21 目标 2：基于干预内容和方法的反馈。 目标1的结果，探讨可行性和可接受性 随后对较大的 R33 相进行精炼。 Suubi-Mhealth 小规模（N = 30），以告知 2. R33目标1：测试Suubi的初步影响- Mhealth 与等候名单对照组 (N=200) 相比，对青少年结果（抑郁症、ART 依从性、心理健康 R33 目标 2：检查整合 Suubi-Mhealth 的障碍和促进因素。 该研究将在大马萨卡地区的 10 个卫生诊所进行。 在乌干达南部，我们期望 Suubi-Mhealth 成为一种可接受且可行的移动医疗工具，以减少 抑郁症，提高 ART 依从性和 YLHIV 的整体心理健康功能。 试点项目前景广阔，那么下一步是 R01 在更大规模的试验中严格测试 Suubi-Mhealth，涵盖 乌干达多个地点。