Determinants of Resilience in Youth with HIV infection and Youth affected by HIV

感染艾滋病毒的青少年和受艾滋病毒影响的青少年的复原力决定因素

• 批准号: 9144865
• 负责人: Jintanat Ananworanich
• 金额: $ 47.42万
• 依托单位: HENRY M. JACKSON FDN FOR THE ADV MIL/MED
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-12 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9144865
• 关键词: AIDS/HIV problem; Adolescence; Adolescent; Adult; Affect; Africa; Age; Anisotropy; Anti-Retroviral Agents; Area; Asia; Attention; Behavior assessment; Behavioral; Brain; Brain imaging; Cambodia; Cambodian; Caregivers; Child; Child Mortality; Childhood; Chronic; Clinical; Cognition; Cognitive; Cohort Studies; Communication; Competence; Complex; Data; Data Set; Decision Making; Development; Diffusion Magnetic Resonance Imaging; Drug Exposure; Emotional; Enrollment; Family; Funding; Goals; Growth; HIV; HIV Infections; Health; Health Status; Health behavior outcomes; Human; Illicit Drugs; Informal Social Control; Knowledge; Letters; Life; Measures; Mental Health; Modeling; Monitor; Motivation; National Institute of Mental Health; Outcome; Perinatal; Population; Positioning Attribute; Prefrontal Cortex; Preventive Intervention; Principal Investigator; Provider; Randomized; Regulation; Research; Research Personnel; Risk; Scientific Advances and Accomplishments; Self Perception; South Africa; South African; Stress; Symptoms; Techniques; Testing; Thailand; Translating; United States National Institutes of Health; Unsafe Sex; Work; Youth; behavior measurement; behavioral health; brain volume; cognitive ability; cognitive function; cohort; coping; design; executive function; experience; follow-up; frontal lobe; illicit drug use; improved; innovation; interest; low and middle-income countries; meetings; neurodevelopment; neuroimaging; novel; peer; prenatal; public health relevance; resilience; skills; social; theories; visual motor

DESCRIPTION (provided by applicant): There are 3.3 million perinatally HIV-infected (paHIV+) children living with HIV worldwide. PaHIV+ and HIV-exposed but uninfected (HEU) youth are both at risk for adverse cognitive and behavioral health outcomes. The vast majority of these youth live in low- and middle-income countries (LMIC) with over 200,000 paHIV+ and millions of HEU youth in Asia alone. With increased availability of effective antiretroviral treatment, the number of new cases, as well as child mortality has both decreased. But, providers are now challenged to meet the complex needs of a growing number of surviving youth who must cope with HIV as a chronic, highly stigmatized, and transmittable illness. With this rationale, we will identify critical determinants for resilience, defined as "competence durin adolescence in cognitive, emotional and behavioral functioning in the face of adverse circumstances". Our central hypothesis is that paHIV+ youth will have compromised abilities relative to their HEU peers, but in both groups, critical determinants for competency will exist. We leverage the availability of paHIV+ and HEU children enrolled in the NIH-funded PREDICT study with up to 8 years of clinical, cognitive and neuroimaging follow-up. The PREDICT study showed less optimal neurodevelopment outcomes in paHIV+ ages 3-15 years compared to their HEU and HIV-unexposed/uninfected peers. As children progress through adolescence, it is critical to monitor the development of executive function, including decision making, planning, and self-regulation, and to understand the development of the frontal lobe and other brain areas that subserve executive function throughout life. This proposed work will examine higher cognition, executive, emotional and behavioral functioning, and identify the determinants of resilience in paHIV+ and HEU adolescents as guided by the modified social action theory (contextual, social regulation and motivation/capabilities factors). The study will also determine the neuroanatomical correlates for risk and resilience using novel techniques to measure brain volume and integrity with particular interest in the prefrontal cortex area. Moreover, in order to understand the needs of this population globally, the study will examine determinants of resilience across culturally settings by comparing the resulting data to similar data sets from two US and one South African cohorts. Our long-term goal is to translate knowledge on the determinants of resilience into preventive interventions that will promote health in millions of paHIV+ and HEU youth worldwide.

描述（由申请人提供）：全世界有330万个受艾滋病毒感染的（PAHIV+）儿童。 Pahiv+和HIV暴露但未感染的（HEU）青年都有不利的认知和行为健康结果的风险。这些年轻人中的绝大多数生活在低收入和中等收入国家（LMIC），仅亚洲就有200,000多名PAHIV+和数百万的HEU青年。随着有效抗逆转录病毒治疗的可用性增加，新病例的数量以及儿童死亡率都在减少。但是，现在挑战提供者要满足越来越多的幸存年轻人的复杂需求，他们必须应对艾滋病毒作为长期，高度污名化和可传染的疾病。有了这个基本原理，我们将确定具有弹性的关键决定因素，并被定义为“面对不利环境的认知，情感和行为功能中的杜林青春期的能力”。我们的核心假设是，Pahiv+青年将相对于其HEU同龄人具有损害能力，但是在这两个群体中，都将存在关键的能力决定因素。我们利用Pahiv+和HEU儿童的可用性，该儿童参加了NIH资助的预测研究，并进行了多达8年的临床，认知和神经影像的随访。预测研究表明，与HEU和未暴露于HIV/未感染的同伴相比，PAHIV+年龄在3-15岁之间的最佳神经发育结果较少。随着儿童在青春期的发展，监测执行功能的发展，包括决策，计划和自我调节，并了解额叶和其他大脑区域的发展，这些发展至关重要。这项拟议的工作将检查更高的认知，执行，情感和行为功能，并确定Pahiv+和HEU青少年中的弹性决定因素，这些因素在改良的社会行动理论（上下文，社会调节和动机/能力因素）的指导下。这项研究还将确定使用新型技术来确定风险和弹性的神经解剖学相关性，以测量对前额叶皮层区域的脑量和完整性，并具有特别的兴趣。此外，为了了解全球该人群的需求，该研究将通过将所得数据与来自两个的相似数据集进行比较，从 我们和一个南非队列。我们的长期目标是将弹性决定因素的知识转化为预防干预措施，这些干预措施将促进全球数百万Pahiv+和HEU青年的健康。