Integrating Mental Health into a HIV Clinic to Improve Outcomes in Tanzanian Youth

将心理健康纳入艾滋病毒诊所，以改善坦桑尼亚青年的治疗结果

• 批准号: 8815436
• 负责人: Dorothy E. Dow
• 金额: $ 13.51万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8815436
• 关键词: Academic Medical Centers; Address; Adherence; Adolescence; Adolescent; Adult; Age; Behavior; Behavioral; Biometry; Caring; Child; Childhood; Chronic stress; Clinic; Clinical Psychology; Clinical Trials; Cognitive; Cognitive Therapy; Collaborations; Communicable Diseases; Comorbidity; Data; Development Plans; Disclosure; Disease; Educational Curriculum; Emotional; Enrollment; Event; Faculty; Feasibility Studies; Focus Groups; Future; Gender; Goals; Grant; Group Therapy; HIV; HIV Seropositivity; HIV-1; HIV-infected adolescents; Hair; Health; Health Personnel; Health Policy; Health Professional; Health education; High Prevalence; Institutes; Intervention; Language; Lead; Life; Master of Science; Measures; Medical; Medical center; Mental Depression; Mental Health; Mental Health Services; Mentors; Mentorship; Modeling; Morbidity - disease rate; Orphan; Outcome; Participant; Pediatrics; Pharmaceutical Preparations; Physicians; Prevalence; Prevention; Professional counselor; Protocols documentation; Psychiatrist; Psychologist; Psychotherapy; Questionnaires; RNA; Randomized; Randomized Controlled Trials; Reporting; Research; Research Methodology; Research Personnel; Resources; Risk; Sampling; Sexuality; Site; Stress; Structure; Symptoms; Tanzania; Teenagers; Therapeutic; Training; Training Programs; Translating; Trauma; Treatment Efficacy; Universities; Viral; Vulnerable Populations; Work; Youth; age group; antiretroviral therapy; base; career; career development; clinical care; common treatment; depressive symptoms; design; evidence base; experience; global health; health inequalities; improved; interdisciplinary approach; meetings; mortality; multidisciplinary; novel; patient oriented research; physical conditioning; post-traumatic stress; professor; programs; psychologic; psychosocial; public health relevance; scale up; sexual HIV transmission; sexually active; skills; skills training; therapy adherence; tool; trial design

DESCRIPTION (provided by applicant): Dr. Dorothy Dow has a Master's of Science in Global Health and will become junior faculty at Duke University Medical Center in the Division of Pediatric Infectious Diseases in July 2014. For nearly three years, she has been living and working in Moshi, Tanzania. Her long-term goal is to become an independent global health researcher integrating mental health into the prevention and treatment of HIV among adolescents. During HIV clinic both at Duke University and Kilimanjaro Christian Medical Centre (KCMC), Dr. Dow has come to realize the reality of the statement, "no health without mental health." Her preliminary research evaluating the prevalence of mental health difficulties among HIV-positive adolescents in Tanzania has demonstrated symptoms of depression and trauma are prevalent in the local HIV youth clinic. Despite these findings, there are no psychologists or psychiatrists currently available at KCMC. This proposed career development plan incorporates a multidisciplinary five-year program complete with didactic training in global mental health, research methods and trial design, advanced biostatistics, and management skills for implementing large clinical trials. These didactics closely align with a mentored, patient-oriented research experience designing, adapting, and implementing a mental health intervention in the HIV adolescent clinic. Dr. Dow will receive mentorship from Dr. Coleen Cunningham (Chief, Pediatric Infectious Diseases and Pediatric Global Health), Dr. Karen O'Donnell (Clinical Psychology), Dr. Kathryn Whetten (Director of the Center for Health Policy and Inequalities Research), Dr. Blandina Mmbaga (Co-Site leader KCMC-Duke Collaboration, Professor of Pediatrics), and consultants Dr. John Bartlett (Duke Global Health Institute, DGHI) and Dr. Kathleen Sikkema (Clinical Psychology). Dr. Dow proposes to integrate both a HIV educational curriculum and an intensive cognitive behavioral therapy (CBT) and life skills training program called SPARCS, into the HIV teen clinic. The first aim is to create a tool kit by adapting both a HIV educational curriculum and SPARCS to be culturally relevant and in Swahili language. The second aim is a feasibility study to determine if SPARCS improves mental health, adherence, and viral outcomes. Based on the work of Dr. Dow's mentors who have successfully implemented trauma-focused CBT among orphans in Tanzania, it is anticipated that SPARCS will also be feasible to implement in a resource-limited setting. The hypothesis is that by addressing mental health needs, youth will demonstrate improved ART adherence and improved virologic outcomes. This project is anticipated to improve both mental and physical health of HIV-positive adolescents in Tanzania and open a dialogue of discussion around mental health difficulties in this setting. Upon completion of this feasibility study and further didactics and mentorship, the candidate plans to submit a R01 grant to evaluate the efficacy of this intervention as a randomized controlled trial, fulfilling her goal of conducting independent global health research to improve the overall health of adolescents living in Tanzania and other resource-limited settings.

描述（由申请人提供）：Dorothy Dow博士拥有全球卫生科学硕士学位，并将于2014年7月成为小儿传染病分部的杜克大学医学中心的初级教职员工。她已经将近三年了，她一直在坦桑尼亚的Moshi居住和工作。她的长期目标是成为一名独立的全球卫生研究者，将心理健康纳入青少年的艾滋病毒的预防和治疗。在杜克大学和乞力马扎罗基督教医学中心（KCMC）的艾滋病毒诊所期间，道尔博士已经意识到了“没有心理健康的健康”的现实。她的初步研究评估了坦桑尼亚的艾滋病毒阳性青少年中心理健康困难的流行，这表明抑郁症和创伤的症状在当地的HIV青年诊所普遍存在。尽管有这些发现，但KCMC目前仍未提供心理学家或精神科医生。该提议的职业发展计划纳入了一个多学科的五年计划，并通过全球心理健康，研究方法和试验设计，高级生物统计学以及实施大型临床试验的管理技能进行了教学培训。这些教学与受到患者的指导，以患者为导向的教学法紧密一致 研究经验在HIV青少年诊所设计，适应和实施心理健康干预措施。 DOW博士将获得Coleen Cunningham博士（儿科感染疾病和儿科全球健康），Karen O'Donnell博士（临床心理学），Kathryn Whetten博士（Karen O'Donnell博士），Kathryn Whetten博士（健康政策与不平等研究中心）主任Blandina Mmbaga（Blandina Mmbaga博士） Bartlett（DGHI杜克全球健康研究所）和凯瑟琳·西克马（Kathleen Sikkema）博士（临床心理学）。 Dow博士建议将HIV教育课程和强化认知行为疗法（CBT）和名为SPARCS的生活技能培训计划集成到HIV青少年诊所。第一个目的是通过调整艾滋病毒教育课程和Sparcs与文化相关和斯瓦希里语语言来创建工具套件。第二个目的是一项可行性研究，以确定SPARC是否可以改善心理健康，依从性和病毒效果。基于Dow博士的导师的工作，他们在坦桑尼亚的孤儿中成功实施了以创伤为中心的CBT，预计在资源有限的环境中实施SPARC也将是可行的。假设是，通过满足心理健康需求，青年将表现出改善的艺术依从性和改善的病毒学结果。预计该项目将改善坦桑尼亚的HIV阳性青少年的心理和身体健康，并在这种情况下围绕心理健康困难进行讨论的对话。这项可行性研究以及进一步的教学和指导完成后，候选人计划提交R01赠款，以评估这种干预措施作为一项随机对照试验的疗效，实现了她进行独立的全球健康研究的目标，以改善坦桑尼亚居住在坦桑尼亚的青少年的整体健康和其他资源限时的环境。