HIV Prevention for Batswana Youth: Adaptation of an Evidence-Based Intervention

博茨瓦纳青年的艾滋病毒预防：采用循证干预措施

• 批准号: 8069077
• 负责人: JANET S ST LAWRENCE
• 金额: $ 17.11万
• 依托单位: MISSISSIPPI STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-28 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8069077
• 关键词: 19 year old; AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adult; Advisory Committees; Age; Alcohol consumption; Alcohols; Attention; Behavior; Behavior Therapy; Behavioral; Biological; Botswana; Caring; Cognitive; Collaborations; Communication; Communities; Country; Development; Educational Curriculum; Effectiveness; Evidence based intervention; Evidence based program; Feasibility Studies; Focus Groups; Future; Gender; Gender Role; HIV; Health education; Household; Incidence; Infection; Intervention; Interview; Life; Life Expectancy; Male Circumcision; Measurement; Measures; Mississippi; Monitor; Parents; Participant; Personal Communication; Play; Predatory Behavior; Preparation; Prevalence; Prevention; Prevention program; Primary Prevention; Property; Protocols documentation; Psychometrics; Randomized Controlled Trials; Research; Risk; Risk Factors; Role; Secondary Schools; Sex Characteristics; Sexuality; Stigmata; Strategic Planning; Teenagers; Testing; Training; Translating; Universities; Vertical Disease Transmission; Work; Youth; Zidovudine; age group; base; case finding; combat; conflict resolution; disorder prevention; evidence base; informant; interpersonal conflict; intimate partner violence; pandemic disease; parental monitoring; pregnancy prevention; programs; response; satisfaction; skills; social; social stigma; sugar; trend

DESCRIPTION (provided by applicant): Botswana has the 2nd highest HIV prevalence in the world, peaking at 40.2% in 30-34 year olds. Botswana also has been the world's leader in providing universal free access to AZT, prevention of mother to child transmission, an extensive network of VCT centers, and a nationwide male circumcision program. However, this emphasis on biomedical strategies for case finding, care, and treatment has not been paralleled by primary prevention programs. The new national strategic plan to be issued in 2010 now places importation and adaptation of evidence-based behavioral prevention as the highest strategic priority for the immediate future. It is in response to the new strategic plan that this collaborative R34 proposal to adapt and pilot an evidence-based program, the Becoming a Responsible Teen (BART) intervention, for Batswana youth is submitted. Guided by a teen advisory committee and a community advisory board, we will conduct focus groups with youth and in-depth interviews with key informants in the first year to inform adaptation of the measurement protocol and intervention for youths 14-19 in Gabarone secondary schools. In the 2nd year, measures will be pilot tested to establish their psychometric properties and to compare responses by gender. Role play vignettes will be drafted, their social and ecological validity assessed, and the BART intervention will be adapted for Batswana adolescents. New culturally appropriate modules addressing alcohol as a risk factor, conflict resolution to reduce intimate partner violence, and stigma reduction will be added. In addition, a new 3-session intervention for parents and a separate 3-session program for household caretakers will be added, addressing HIV/AIDS information, communicating with youth on sensitive topics, and monitoring, In the 3rd year, a pilot feasibility study will assess recruitment, retention, interventionists' fidelity, and youth and parents/caretakers' response to their respective interventions, and whether the results suggest that the Botswana version of BART provides value added when compared against the existing Life Skills curriculum in the secondary schools. This developmental application is the first step in a programmatic sequence developed in collaboration between the University of Botswana, governmental agencies and NGOs in Gaborone, and Mississippi State University. If the feasibility trial documents positive changes in behavior, it will inform a R01 application for a larger randomized controlled trial with cognitive, behavioral and biological endpoints. If the RCT provides strong evidence of effectiveness, we will work with the Ministries of Education, Health, and Youth and Culture to disseminate the intervention throughout Botswana's secondary schools and train staff in each community to deliver the program with fidelity. PUBLIC HEALTH RELEVANCE: Botswana is one of the two countries hardest hit by AIDS anywhere in the world with adult prevalence that peaks at 40.2% in 30-34 year olds. As a result, life expectancy is reduced from 70 to 33 years. An estimated 37-39% of Botswana's adults between the ages of 15-49 are HIV-infected in contrast to the sub-Saharan average of 5.0%. Despite extensive efforts by Botswana governmental and non- governmental organization s (NGOs) to combat the pandemic through testing, universal treatment, and male circumcision, these biomedical strategies have not been paralleled by attention to effective behavioral interventions. A new national strategic plan to be released in 2010 identifies behavioral primary prevention for youth based on evidence-based programs as the highest priority for the next three years. This proposal to adapt BART, an evidence-based HIV prevention program of proven effectiveness, for Botswana youth is timely, responding to the new national priorities that refocus attention to primary prevention in order to reduce the incidence of new infections, especially among youth.

描述（由申请人提供）：博茨瓦纳是世界上艾滋病毒感染率第二高的国家，30-34 岁人群的感染率最高为 40.2%。博茨瓦纳在普及免费 AZT、预防母婴传播、广泛的 VCT 中心网络以及全国性男性包皮环切计划方面也一直处于世界领先地位。然而，对病例发现、护理和治疗的生物医学策略的重视并没有与初级预防计划相提并论。 2010年即将发布的新国家战略计划将导入和采用循证行为预防作为近期的最高战略优先事项。正是为了响应新的战略计划，我们提交了 R34 合作提案，以适应和试点一项针对博茨瓦纳青年的循证计划，即成为负责任的青少年 (BART) 干预措施。在青少年咨询委员会和社区咨询委员会的指导下，我们将在第一年对青少年进行焦点小组讨论，并对主要知情人进行深入访谈，为哈博罗内中学 14-19 岁青少年调整测量方案和干预措施提供信息。第二年，将对措施进行试点测试，以确定其心理测量特性并按性别比较反应。将起草角色扮演小插曲，评估其社会和生态有效性，并将针对博茨瓦纳青少年调整 BART 干预措施。将添加新的文化上适当的模块，解决酒精作为危险因素、解决冲突以减少亲密伴侣暴力以及减少耻辱的问题。此外，还将增加针对父母的新的 3 次会议干预措施和针对家庭看护者的单独 3 次会议计划，涉及艾滋病毒/艾滋病信息、与青少年就敏感话题进行沟通以及监测。在第三年，开展试点可行性研究将评估招募、保留、干预者的忠诚度以及青少年和家长/看护者对其各自干预措施的反应，以及结果是否表明博茨瓦纳版本的 BART 与中学现有的生活技能课程相比提供了附加值学校。这一开发应用程序是博茨瓦纳大学、哈博罗内政府机构和非政府组织以及密西西比州立大学合作开发的计划序列的第一步。如果可行性试验记录了行为的积极变化，它将为 R01 申请提供更大规模的具有认知、行为和生物学终点的随机对照试验的信息。如果随机对照试验提供了有效的有力证据，我们将与教育部、卫生部以及青年和文化部合作，在博茨瓦纳的中学中传播干预措施，并培训每个社区的工作人员忠实地实施该计划。 公共卫生相关性：博茨瓦纳是世界上受艾滋病影响最严重的两个国家之一，成人患病率在 30-34 岁人群中达到峰值 40.2%。结果，预期寿命从 70 岁缩短至 33 岁。据估计，博茨瓦纳 15-49 岁的成年人中有 37-39% 感染艾滋病毒，而撒哈拉以南地区的平均感染率为 5.0%。尽管博茨瓦纳政府和非政府组织（NGO）通过检测、普遍治疗和男性包皮环切术为抗击这一流行病做出了广泛的努力，但这些生物医学策略并未与对有效行为干预措施的关注相提并论。将于 2010 年发布的新国家战略计划将基于循证计划的青少年行为一级预防确定为未来三年的最高优先事项。这项针对博茨瓦纳青年调整 BART（一项经证明有效的循证艾滋病毒预防计划）的提议是及时的，响应了新的国家优先事项，重新将注意力集中在初级预防上，以减少新感染的发生率，特别是在青年中。