HIV and Substance Use Prevention for South African Youth and Families

南非青少年和家庭的艾滋病毒和药物使用预防

• 批准号: 8015164
• 负责人: GERI R DONENBERG
• 金额: $ 20.95万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-10 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015164
• 关键词: 16 year old; 18 year old; AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adolescent Development; Affect; Affective; Africa South of the Sahara; African; Age; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Attention; Attitude; Awareness; Back; Behavior; Behavioral; Belief; Blood; Caregivers; Centers for Disease Control and Prevention (U.S.); Characteristics; Chicago; Child; Cities; Coercion; Color; Communication; Communities; Complex; Consent; Control Groups; Data; Decision Making; Development; Diagnosis; Drug usage; Economics; Educational Curriculum; Educational process of instructing; Effectiveness; Epidemic; Ethnic group; Evaluation; Failure; Family; Family Process; Family member; Feedback; Female; Focus Groups; Gender; Gender Role; Goals; Government; Guidelines; HIV; HIV Infections; Happiness; Health; Health Personnel; Healthcare; Human; Illinois; Individual; Infection; Intervention; Interview; Knowledge; Length; Life; Life Experience; Link; Mediator of activation protein; Mental Health; Mental Health Services; Mental disorders; Mentally Ill Persons; Modeling; Nature; Outcome; Outpatients; Parenting behavior; Parents; Participant; Partner Communications; Pediatric Hospitals; Personal Attribute; Personal Power; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Positioning Attribute; Poverty; Preparation; Prevalence; Prevention; Prevention program; Prevention strategy; Procedures; Process; Psychiatric Hospitals; Psychiatric therapeutic procedure; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Red Cross; Relative (related person); Reporting; Research; Research Design; Research Project Grants; Resources; Risk; Risk Behaviors; Risk-Taking; Role; Sample Size; School-Age Population; Science; Self Efficacy; Sex Behavior; Sexual Health; Sexual Partners; Site; Social Environment; Social Power; South Africa; Staging; Strategic Planning; Substance abuse problem; Suggestion; Survey Methodology; Surveys; Teenagers; Testing; Time; Translating; Translations; Universities; Vulnerable Populations; War; Work; World Health Organization; Youth; alcohol and other drug; alcohol behavior; arm; base; behavior change; catalyst; condoms; consistent condom use; cultural values; delay sex; design; drug abuse prevention; effectiveness trial; emotion regulation; empowered; experience; follow up assessment; follow-up; high risk; high risk sexual behavior; improved; innovation; male; multidisciplinary; parent-child communication; parental influence; parental monitoring; peer; peer influence; prevent; programs; public health priorities; public health relevance; randomized trial; role model; safer sex; sex; sex risk; skills; social; stem; substance use prevention; theories; therapy development; transmission process; treatment effect

DESCRIPTION (provided by applicant): South Africa (SA) has the largest number of people living with HIV/AIDS (PLWHA) in the world. Youth in SA are experiencing the fastest increase in new HIV infections, and in the Western Cape region, new infections are increasingly fueled by mental health problems and substance use. Families can be effective collaborators in HIV prevention efforts, but no family-based interventions exist for South African teens, particularly those with mental health problems and drug/alcohol use. This developmental study will adapt and pilot test a multi-level, highly promising, HIV and alcohol/drug use prevention program (Project STYLE) for South African caregivers and their teens receiving outpatient mental health services. Project STYLE was designed and tested with 750 mentally ill teens across three US cities, and we will systematically adapt it for the South African context using a combination of ADAPT-ITT and CDC guidelines. Stage 1 will involve extensive formative work (e.g., focus groups, feedback groups, in-depth interviews, theater testing), revisions to survey instruments and the curriculum, and translation/back-translation into Afrikaans and isiXhosa. We will assemble a CAB to advise in the adaptations and revisions. In Stage 2, we will pilot test the revised intervention with two groups of 14 - 18 year old parent-teen dyads receiving mental health services. Teens will be male and female from all ethnic groups (i.e., White, Black, and Colored). We will revise study procedures and materials based on comprehensive participant evaluations, observations, and facilitator ratings. In Stage 3, we will re-test the revised program with 60 parent-teen dyads randomly assigned to Project STYLE versus a control group. All participants will complete baseline and 3-month follow-up interviews to evaluate tracking, retention, and preliminary treatment effects. Guided by a Social-Personal framework6 of HIV-risk and the Theory of Gender and Power, the intervention will target personal attributes, peer and partner relationship processes, and family context to reduce risky sexual behavior and drug/alcohol use among South African youth. Given the exploratory nature of the study, we will cautiously examine change in theoretical mediators and risky sexual behavior and substance abuse as a function of program participation, and we will determine the pretest-posttest effect size of program impact on HIV-risk behavior between groups. The long-term goal of the study is to adapt a highly promising and scientifically-based HIV and substance use prevention program for South African teens and parents that can be tested in a large-scale effectiveness study. This study is consistent with R34 guidelines to support the early phase of intervention development and preliminary testing to examine feasibility, acceptability, and tolerability. PUBLIC HEALTH RELEVANCE: Sub-Saharan Africa is the global epicenter of the AIDS epidemic, and South Africa is estimated to have the largest number of people living with HIV/AIDS in the world. With youth experiencing the fastest increase in new HIV infections in South Africa, stemming transmissions is a global public health priority. Unfortunately, national efforts have been disappointing; 50% of South African youth are sexually experienced, 25% were previously diagnosed with an STI, and 40% report sexual activity involving blood. Similarly, adolescent rates of alcohol and other drug use are rising, and age at first use (13 - 16 years old) for the majority (54%) is young. Likewise, despite high-risk taking among teens in psychiatric care, and the World Health Organization's statement that "there can be no health without mental health," mental health has been a low priority in South Africa. Disproportionate rates of HIV infection among South Africans may reflect, in part, few available mental health services, while improved mental health care may reduce the spread of HIV/AIDS. In the Western Cape region of South Africa, associations among sexual risk taking, alcohol and drug use, and mental illness are fueling HIV/AIDS infections among youth. Families can be effective collaborators in HIV prevention efforts, but no family-based interventions exist for South African teens, particularly those with mental health problems and drug/alcohol use. This developmental study will adapt and pilot test a multi-level, highly promising, HIV and alcohol/drug use prevention program (Project STYLE) for this exceptionally high-risk population. Simultaneously addressing sexual risk taking, mental health, and substance use among South African youth has the potential to reduce these intersecting epidemics. The long-term goal of the proposed project is to develop an empirically-validated, theoretically-based family-focused HIV and substance use prevention program to reduce health risk behavior among South African youth with mental health problems.

描述（由申请人提供）：南非 (SA) 是世界上艾滋病毒/艾滋病感染者 (PLWHA) 人数最多的国家。南澳青年的艾滋病毒新感染人数增长最快，而在西开普地区，精神健康问题和药物滥用日益加剧新感染病例。家庭可以成为艾滋病毒预防工作的有效合作者，但对于南非青少年，特别是那些有心理健康问题和吸毒/酗酒的青少年，不存在基于家庭的干预措施。这项发展研究将为接受门诊心理健康服务的南非护理人员及其青少年调整和试点测试一个多层次、前景广阔的艾滋病毒和酒精/毒品使用预防计划（项目风格）。 Project STYLE 是在美国三个城市的 750 名患有精神疾病的青少年中进行设计和测试的，我们将结合 ADAPT-ITT 和 CDC 指南，系统地对其进行调整，以适应南非的情况。第一阶段将涉及广泛的形成性工作（例如焦点小组、反馈小组、深入访谈、戏剧测试）、调查工具和课程的修订以及南非荷兰语和伊科萨语的翻译/回译。我们将组建一个 CAB，为调整和修订提供建议。在第二阶段，我们将在两组接受心理健康服务的 14 至 18 岁父母青少年群体中试点测试修订后的干预措施。青少年将是来自所有种族群体（即白人、黑人和有色人种）的男性和女性。我们将根据参与者的综合评估、观察和辅导员评分来修改研究程序和材料。在第三阶段，我们将重新测试修订后的计划，将 60 名家长与青少年随机分配到“项目风格”组与对照组进行对比。所有参与者将完成基线和 3 个月的随访访谈，以评估跟踪、保留和初步治疗效果。在艾滋病毒风险社会-个人框架6以及性别与权力理论的指导下，干预措施将针对个人属性、同伴和伴侣关系过程以及家庭背景，以减少南非青年中的危险性行为和吸毒/酗酒。鉴于该研究的探索性，我们将谨慎地研究理论中介因素以及危险性行为和药物滥用的变化作为计划参与的函数，并且我们将确定计划对群体之间艾滋病毒风险行为影响的前测-后测效应大小。该研究的长期目标是为南非青少年和家长制定一项极具前景且基于科学的艾滋病毒和药物使用预防计划，该计划可以在大规模有效性研究中进行测试。本研究符合 R34 指南，支持干预开发的早期阶段和初步测试，以检查可行性、可接受性和耐受性。 公共卫生相关性：撒哈拉以南非洲地区是全球艾滋病流行的中心，据估计南非是世界上艾滋病毒/艾滋病感染者人数最多的国家。南非青年人的新艾滋病毒感染人数增长最快，阻止传播已成为全球公共卫生的优先事项。不幸的是，国家的努力却令人失望。 50% 的南非年轻人有过性经历，25% 的人曾被诊断患有性传播感染，40% 的人报告涉及血液的性行为。同样，青少年酒精和其他药物的使用率也在上升，而且大多数人 (54%) 首次使用的年龄（13 - 16 岁）都很年轻。同样，尽管青少年接受精神科护理的风险很高，而且世界卫生组织也声明“没有心理健康就没有健康”，但在南非，心理健康一直没有得到重视。南非人艾滋病毒感染率过高可能部分反映了可用的精神卫生服务很少，而改善精神卫生保健可能会减少艾滋病毒/艾滋病的传播。在南非西开普地区，性冒险、酗酒和吸毒以及精神疾病之间的联系正在加剧青少年中艾滋病毒/艾滋病的感染。家庭可以成为艾滋病毒预防工作的有效合作者，但对于南非青少年，特别是那些有心理健康问题和吸毒/酗酒的青少年，不存在基于家庭的干预措施。这项发展研究将为这一异常高危人群调整并试点测试一个多层次、前景广阔的艾滋病毒和酒精/毒品使用预防计划（项目风格）。同时解决南非青少年的性冒险、心理健康和药物滥用问题，有可能减少这些交叉流行病的发生。该项目的长期目标是制定一项经过实证验证、以理论为基础、以家庭为中心的艾滋病毒和药物使用预防计划，以减少有心理健康问题的南非青年的健康风险行为。