VUKA Family Program: Supporting Perinatally HIV-infected Youth in South Africa

VUKA 家庭计划：支持南非围产期感染艾滋病毒的青少年

• 批准号: 8517169
• 负责人: Mary McKernan McKay
• 金额: $ 73.39万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8517169
• 关键词: 14 year old; AIDS prevention; Address; Adherence; Adolescence; Adolescent; Adult; Africa; African; Anti-Retroviral Agents; Asia; Behavior; Behavioral; Caregivers; Caring; Cartoons; Child; Chronic; Clinic; Cohort Studies; Collaborations; Communities; Complex; Country; Data; Decision Making; Drug usage; Effectiveness; Family; Family member; Funding; Generations; HIV; HIV Infections; HIV Seroprevalence; Health; Health behavior; Household and Family; Housing; Income; Individual; Informal Social Control; Intervention; Mediating; Medical; Medical Staff; Mental Health; Modeling; Outcome; Perception; Perinatal; Personal Satisfaction; Pharmaceutical Preparations; Population; Prevalence; Process; Professional counselor; Province; Public Health; Randomized; Randomized Controlled Trials; Regulation; Relative (related person); Research; Research Design; Research Personnel; Resources; Risk; Risk Behaviors; Sampling; Science; Secondary to; Site; South Africa; Testing; Theoretical model; Time; Viremia; Youth; artist; base; behavioral health; contextual factors; coping; design; follow-up; medical appointment; meetings; novel; pediatric human immunodeficiency virus; programs; psychosocial; research study; skills; skills training; social; standard care; standard of care; theories; transmission process; treatment adherence

DESCRIPTION (provided by applicant): The primary aim of the proposed study is to meet the urgent need for theory-driven, empirically- informed, effective, and sustainable HIV prevention and care approaches for the unprecedented numbers of perinatally HIV-infected (PHIV+) youth in South Africa (SA). This study aims to 1) increase our understanding of behavioral and health risk in this emerging population, and 2) to examine the impact of a family/household-level intervention, the VUKA Family Program (VUKA), to promote youth overall health and mental health, and reduce behavioral risk. Informed by Social Action Theory, (SAT); and the PRISM (Practical, Robust Implementation and Sustainability Model) theoretical framework, VUKA is a cartoon-based intervention developed with intensive input from SA investigators, graphic artists, medical staff, adult caregivers and HIV+ adolescents. This application is built upon a long-standing collaboration among US and SA researchers and clinicians and the SA Department of Health (SADOH). We propose a full-scale randomized controlled trial (RCT) to examine the effectiveness, implementation, and integration processes associated with VUKA with a sample of 360 PHIV+ early adolescents (9 to 14 years of age) registered at 4 publicly financed pediatric HIV clinics in KwaZulu Natal, a SA province with one of the highest HIV seroprevalence rates. Youth and their family members will be randomly assigned to one of two study conditions: 1) VUKA or; 2) standard of care. A 3-wave experimental research design with assessments at baseline, 3 month (posttest) and 12 month follow-up from baseline will be employed to address the following Specific Aims. Aim #1 (Primary): To identify the behavioral (e.g., ART adherence, engagement in sexual and drug use behaviors), health (e.g., level of viremia, general health), and psychosocial (e.g mental health, connection to protective adult resources, social decision-making skills) risks of the emerging population of PHIV+ youth in South Africa, guided by our SAT model (Figure 1) and based on baseline data collected as part of the proposed RCT. Aim #2 (Primary): To examine the impact of VUKA on youth behavioral, health and psychosocial outcomes relative to those who receive standard care within South African public medical clinics. Aim #3 (Secondary): To investigate how outcomes are mediated by theoretical constructs in our SAT model (self-regulation, social/family regulation, and contextual factors); Aim #4 (Secondary): To elucidate multi-level factors guided by PRISM that influence implementation, and integration of VUKA (e.g. staff delivery skill, perceptions of burden, clinic organizational challenges, time and space constraints) in publicly funded, pediatric HIV care sites in KwaZulu-Natal, SA).

描述（由申请人提供）：拟议研究的主要目的是满足对空前数量的围产期 HIV 感染者 (PHIV+) 的理论驱动、经验丰富、有效和可持续的 HIV 预防和护理方法的迫切需求。南非（SA）的青年。本研究旨在 1) 增进我们对这一新兴人群的行为和健康风险的了解，2) 研究家庭/家庭层面的干预措施——VUKA 家庭计划 (VUKA) 的影响，以促进青少年的整体健康和心理健康。健康，并降低行为风险。以社会行动理论为基础，（SAT）；和 PRISM（实用、稳健实施和可持续发展模型）理论框架，VUKA 是一种基于卡通的干预措施，得到了 SA 调查人员、图形艺术家、医务人员、成人护理人员和 HIV + 青少年的大量投入。该应用程序建立在美国和南澳研究人员、临床医生以及南澳卫生部 (SADOH) 之间的长期合作基础上。我们建议开展一项全面的随机对照试验 (RCT)，以在 4 个公共资助的儿科 HIV 诊所注册的 360 名 PHIV+ 早期青少年（9 至 14 岁）为样本，检查与 VUKA 相关的有效性、实施和整合过程。夸祖鲁纳塔尔省是南非艾滋病毒血清阳性率最高的省份之一。青少年及其家庭成员将被随机分配到以下两种学习条件之一：1) VUKA 或； 2）护理标准。将采用 3 波实验研究设计，包括基线评估、3 个月（测试后）和基线 12 个月随访，以实现以下具体目标。目标#1（主要）：确定行为（例如，ART 依从性、性行为和吸毒行为）、健康（例如，病毒血症水平、总体健康状况）和社会心理（例如，心理健康、与保护性成人资源的联系）以我们的 SAT 模型（图 1）为指导，并基于作为拟议 RCT 的一部分收集的基线数据，研究了南非新兴 PHIV+ 青年群体的风险（社会决策技能）。目标#2（主要）：相对于在南非公共医疗诊所接受标准护理的青少年，研究 VUKA 对青少年行为、健康和心理社会结果的影响。目标#3（次要）：研究 SAT 模型中的理论结构（自我调节、社会/家庭调节和背景因素）如何调节结果；目标 4（次要目标）：阐明 PRISM 指导下影响 VUKA 实施和在公共资助的儿科艾滋病毒护理中整合的多层次因素（例如工作人员交付技能、负担观念、诊所组织挑战、时间和空间限制）位于南澳州夸祖鲁-纳塔尔省的工厂）。