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

基本信息

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
项目类别：
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

项目摘要

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 博士拥有全球健康理学硕士学位，将于 2014 年 7 月成为杜克大学医学中心儿科传染病部门的初级教师。近三年来，她一直生活在在坦桑尼亚莫希工作。她的长期目标是成为一名独立的全球健康研究员，将心理健康纳入青少年艾滋病毒的预防和治疗中。在杜克大学和乞力马扎罗基督教医疗中心 (KCMC) 的艾滋病毒诊所期间，陶博士逐渐意识到“没有心理健康就没有健康”这句话的现实意义。她的初步研究评估了坦桑尼亚艾滋病毒阳性青少年心理健康问题的普遍程度，结果表明抑郁和创伤症状在当地艾滋病毒青少年诊所中很普遍。尽管有这些发现，KCMC 目前没有心理学家或精神科医生。这项拟议的职业发展计划包含一个为期五年的多学科计划，包括全球心理健康、研究方法和试验设计、先进生物统计学以及实施大型临床试验的管理技能方面的教学培训。这些教学法与有指导的、以患者为中心的理念紧密结合研究经验在艾滋病毒青少年诊所设计、调整和实施心理健康干预措施。 Dow 博士将接受 Coleen Cunningham 博士（儿科传染病和儿科全球健康主任）、Karen O'Donnell 博士（临床心理学）、Kathryn Whetten 博士（卫生政策和不平等研究中心主任）的指导。、Blandina Mmbaga 博士（KCMC-Duke 合作中心联合负责人、儿科教授）和顾问 John 博士Bartlett（杜克全球健康研究所，DGHI）和 Kathleen Sikkema 博士（临床心理学）。陶博士建议将艾滋病毒教育课程、强化认知行为治疗 (CBT) 和称为 SPARCS 的生活技能培训计划整合到艾滋病毒青少年诊所中。第一个目标是通过调整艾滋病毒教育课程和 SPARCS 使其与文化相关并使用斯瓦希里语来创建一个工具包。第二个目标是一项可行性研究，以确定 SPARCS 是否可以改善心理健康、依从性和病毒感染结果。 Dow 博士的导师在坦桑尼亚的孤儿中成功实施了针对创伤的 CBT，根据他们的工作，预计 SPARCS 也可以在资源有限的环境中实施。假设是，通过解决心理健康需求，青少年将表现出更好的 ART 依从性和更好的病毒学结果。该项目预计将改善坦桑尼亚艾滋病毒呈阳性青少年的心理和身体健康，并就该地区的心理健康困难展开讨论。在完成这项可行性研究以及进一步的教学和指导后，候选人计划提交 R01 拨款，以评估这项干预措施作为随机对照试验的有效性，实现她进行独立的全球健康研究以改善青少年整体健康的目标在坦桑尼亚和其他资源有限的地区。