PS11-003 Minority AIDS Research Initiative

PS11-003 少数民族艾滋病研究计划

• 批准号: 8211957
• 负责人: Bridgette Mercedez Rice
• 金额: $ 13.69万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8211957
• 关键词: PS11; 003; Minority; AIDS; Research

DESCRIPTION (provided by PI): This application is responsive to the fourth research topic in Request for Applications RFA-PS-11-003, "A Sexual Health Approach for Black and Hispanic Youth: New strategies for prevention, screening and facilitating healthy choices." In Philadelphia, PA, urban Black adolescents are disproportionately impacted by unintended sexual outcomes, such as HIV, sexually transmitted infections (STIs) and unwanted pregnancies. Novel studies translated into nontraditional community programs to address overall sexual health and decrease sexual infections are essential for this population. The proposed study is an effort to translate the Principal Investigator's (PI's) preliminary research findings to benefit sexual health education needs identified within the local adolescent mental health community. The PI innovatively proposes the first steps in a program of research to address HIV/STI prevention needs in a historically underserved sector of the Black community- Black adolescents suffering from mental illnesses. The PI is a young African American nurse scientist with a proven track record to implement culturally and linguistically competent research methodology, a history of service to Black communities, strong linkages to the targeted population and outstanding research training through the Center for Health Equity Research at the University of Pennsylvania School of Nursing. Accordingly, a community-based participatory research (CBPR) framework is proposed with mentorship by renowned senior scientists, Drs. Loretta Jemmott and Gina Wingood. Hard to reach, disenfranchised adolescents are at the epicenter of our national HIV/STI epidemic, and those with mental health illnesses are at heightened risk. Early sexual debut, substance abuse, poverty and limited educational attainment are all documented risk factors. Black adolescents with mental illnesses are at increased risk for HIV/STIs because they are more likely to encounter social and structural drivers of the HIV/STI epidemic. Further, research indicates that they engage in HIV/STI risk related sexual behaviors at higher rates than other adolescents. The delivery of HIV/STI prevention programming in a nontraditional setting, such as an outpatient mental health treatment program, may prove effective to engage at-risk Black adolescents with mental illnesses. Behavioral interventions have demonstrated efficacy in the general adolescent population; however, it remains unknown whether these findings translate to adolescents with mental illnesses. To enhance efficacy, interventions for this population should be targeted to account for unique social and psychological factors which may impair their ability to accurately appraise risky situations, control impulses and negotiate condom use. Despite these facts, a paucity of comprehensive evidence-based interventions are available to reduce HIV/STI risk among Black adolescents with mental illnesses. Through a health equity lens, and a social determinants approach to HIV/STI prevention, the purpose of this study is to develop and pilot a theoretically-driven, gender and culturally relevant, developmentally and psychologically appropriate behavioral intervention to reduce the risk of HIV/STIs among heterosexually-active Black adolescents (ages 13 to 17) with mental illnesses. A CBPR framework, the Theory of Planned Behavior, and the investigators' preliminary work with the target population will guide the research process. Both males and females (N= 128) currently receiving outpatient mental health treatment from a Philadelphia Community Behavioral Health (CBH) provider will be randomized to one of two conditions: 1) a targeted HIV/STI risk reduction intervention to reduce their risk of HIV and other STIs; or 2) an attention control condition on general health promotion to reduce their risk of adverse health conditions including cancer, obesity, and heart disease. In partnership with the community, the specific aims are focused on elucidation of factors that influence HIV/STI risk, intervention development, testing the intervention's effects on HIV/STI risk related sexual behavior and STI incidence, and testing the mediation of effects of the intervention. The primary study outcome is self-reported consistent condom use assessed at baseline, immediately post-intervention, and at 3-, 6- and 12-month follow-ups. Secondary outcomes include sexual activity, the number of concurrent and sequential sexual partners, the theoretical mediators of intervention effects (adolescents' attitudes, beliefs, intentions and self-efficacy) and laboratory confirmed STIs. These data will contribute to the development of evidence-based HIV/STI sexual risk reduction programs for Black adolescents with mental illnesses. Specifically, the intended impact is to: 1) generate data to address unique, unmet HIV/STI risk reduction needs via a gender and culturally relevant, developmentally and psychologically appropriate vehicle targeted to reach Black adolescents with mental illnesses; 2) partner with community stakeholders to deliver a novel intervention in a nontraditional setting embedded in the community at risk to enhance sexual health dialogue and prevention efforts between adolescents and trusted adult facilitators; and 3) inform mental health policy toward the standardization of sexual health assessment and intervention in community outpatient mental health treatment. The investigator's long-term goal is to build an HIV epidemiologic prevention program of research focused on decreasing HIV/STI morbidity in highly affected urban Philadelphia, and generalizable to other urban communities. Given that adolescent health is imperative to public health, the proposed research is timely, innovative and bears great significance. PUBLIC HEALTH RELEVANCE: Heterosexually-active Black adolescents diagnosed with mental illnesses report increased rates of early sexual debut, noncondom use, and having sex with multiple sexual partners. Theory-based, gender and culturally relevant HIV/STI risk reduction interventions that focus on the psychopathology of mental illness are needed to improve sexual health within the target population. Delivery of HIV/STI prevention programming in outpatient mental health treatment, a nontraditional community-based setting, may reach adolescents who are not engaged in other settings (i.e. schools and churches).

描述（由 PI 提供）：该应用程序响应 RFA-PS-11-003 申请请求中的第四个研究主题，“黑人和西班牙裔青年的性健康方法：预防、筛查和促进健康选择的新策略。 ”在宾夕法尼亚州费城，城市黑人青少年尤其受到艾滋病毒、性传播感染 (STI) 和意外怀孕等意外性行为的影响。将新颖的研究转化为非传统社区计划来解决整体性健康问题并减少性感染对于这一人群至关重要。拟议的研究旨在将首席研究员 (PI) 的初步研究结果转化为有利于当地青少年心理健康社区内确定的性健康教育需求。 PI 创新性地提出了一项研究计划的第一步，旨在解决黑人社区历史上服务不足的部门（患有精神疾病的黑人青少年）的艾滋病毒/性传播感染预防需求。 PI 是一位年轻的非裔美国护士科学家，在实施文化和语言能力强的研究方法方面拥有良好的记录、为黑人社区提供服务的历史、与目标人群的密切联系以及通过健康公平研究中心提供的出色的研究培训。宾夕法尼亚大学护理学院。因此，在著名资深科学家 Drs. 的指导下，提出了一个基于社区的参与性研究 (CBPR) 框架。洛雷塔·杰莫特和吉娜·温古德。难以接触、被剥夺权利的青少年是全国艾滋病毒/性传播感染流行的中心，而那些患有精神疾病的人则面临更高的风险。过早发生性行为、药物滥用、贫困和受教育程度有限都是有记录的风险因素。患有精神疾病的黑人青少年感染艾滋病毒/性传播感染的风险增加，因为他们更有可能遇到艾滋病毒/性传播感染流行的社会和结构性驱动因素。此外，研究表明，他们从事与艾滋病毒/性传播感染风险相关的性行为的比例高于其他青少年。在非传统环境中提供艾滋病毒/性传播感染预防计划，例如门诊心理健康治疗计划，可能会有效地吸引患有精神疾病的高危黑人青少年。行为干预已在一般青少年群体中显示出有效性；然而，目前尚不清楚这些发现是否适用于患有精神疾病的青少年。为了提高疗效，针对这一人群的干预措施应有针对性地考虑到独特的社会和心理因素，这些因素可能会损害他们准确评估危险情况、控制冲动和协商安全套使用的能力。尽管存在这些事实，但仍缺乏全面的循证干预措施来降低患有精神疾病的黑人青少年感染艾滋病毒/性传播感染的风险。通过健康公平的视角和艾滋病毒/性传播感染预防的社会决定因素方法，本研究的目的是开发和试点一种理论驱动的、性别和文化相关的、发展和心理上适当的行为干预措施，以降低艾滋病毒/性传播感染的风险。患有精神疾病的异性恋活跃黑人青少年（13 至 17 岁）中的性传播感染。 CBPR 框架、计划行为理论以及研究人员对目标人群的初步工作将指导研究过程。目前正在接受费城社区行为健康 (CBH) 提供者门诊心理健康治疗的男性和女性 (N= 128) 将被随机分配到以下两种情况之一：1) 有针对性的 HIV/STI 风险降低干预措施，以降低感染 HIV 的风险和其他性传播感染； 2) 对一般健康促进的注意力控制条件，以降低他们患癌症、肥胖和心脏病等不良健康状况的风险。与社区合作，具体目标侧重于阐明影响 HIV/STI 风险的因素、制定干预措施、测试干预措施对 HIV/STI 风险相关性行为和 STI 发病率的影响，以及测试干预措施效果的中介作用。主要研究结果是自我报告的在基线、干预后以及 3、6 和 12 个月随访时评估的持续使用安全套的情况。次要结果包括性活动、同时发生和相继发生的性伴侣的数量、干预效果的理论中介因素（青少年的态度、信仰、意图和自我效能）以及实验室证实的性传播感染。这些数据将有助于为患有精神疾病的黑人青少年制定基于证据的艾滋病毒/性传播感染性风险降低计划。具体而言，预期影响是：1）生成数据，通过针对患有精神疾病的黑人青少年的性别和文化相关、发展和心理适当的工具，满足独特的、未满足的艾滋病毒/性传播感染风险降低需求； 2) 与社区利益相关者合作，在风险社区的非传统环境中提供新颖的干预措施，以加强青少年和值得信赖的成人促进者之间的性健康对话和预防工作； 3）为社区门诊心理健康治疗中性健康评估和干预的标准化提供心理健康政策信息。研究人员的长期目标是建立一个艾滋病毒流行病学预防研究计划，重点是降低受影响严重的费城城市的艾滋病毒/性传播感染发病率，并推广到其他城市社区。鉴于青少年健康对公共卫生至关重要，本研究及时、创新、意义重大。 公共卫生相关性：被诊断患有精神疾病的异性恋活跃黑人青少年报告，过早性行为、不使用安全套以及与多个性伴侣发生性行为的比例有所增加。需要基于理论、性别和文化相关的艾滋病毒/性传播感染风险降低干预措施，重点关注精神疾病的精神病理学，以改善目标人群的性健康。在门诊心理健康治疗（一种非传统的社区环境）中提供艾滋病毒/性传播感染预防规划，可能会惠及不参与其他环境（即学校和教堂）的青少年。