Suubi4Her: A Combination Intervention Addressing HIV Risk Behaviors Among Older Adolescent Girls Transitioning into Adulthood in Uganda

Suubi4Her：针对乌干达成年期大龄少女的艾滋病毒危险行为的联合干预措施

• 批准号: 9892186
• 负责人: FRED M SSEWAMALA
• 金额: $ 18.36万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9892186
• 关键词: 12 year old; 17 year old; 19 year old; AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Adult; Affect; Africa South of the Sahara; Age; Anxiety; Behavioral; Biological; Businesses; Child; Chlamydia; Cognitive; Communication; Communities; Data; Data Collection; Development; Economics; Education; Effectiveness; Enrollment; Exhibits; Exposure to; Family; Family Relationship; Feeling hopeless; Female; Female Adolescents; Financial Hardship; Fostering; Gender; Gonorrhea; HIV; HIV Infections; HIV risk; Health; Health behavior; Health education; Home environment; Incentives; Infection; Intervention; Marriage; Measures; Mediating; Mediation; Mental Depression; Mental Health; Mental disorders; Outcome; Patient Self-Report; Population; Poverty; Prevalence; Prevention approach; Primary Schools; Process; Public Health; Randomized; Reporting; Research; Resources; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Safe Sex; Safety; Savings; Schools; Secondary Schools; Security; Self Efficacy; Sex Behavior; Sex Education; Sexual Health; Sexually Transmitted Diseases; Student Dropouts; Testing; Time; Training; Treatment Efficacy; Trichomonas; Uganda; United States National Institutes of Health; Viral Load result; Vulnerable Populations; Youth; base; behavioral health; child depression; cost; cost-effectiveness evaluation; emerging adult; empowerment; evidence base; girls; group intervention; high risk sexual behavior; improved; indexing; innovation; intimate partner violence; prevent; programs; protective behavior; public health relevance; secondary outcome; self esteem; sex; sexual risk taking; stressor; theories; young adult; young woman

Aligned with the NIH priority of addressing disparities in new HIV infections and the UNAIDS call for implementing combination HIV prevention approaches, the proposed study will examine the impact and cost associated with Suubi4Her, an innovative combination intervention that aims to prevent HIV risk behaviors among 15-17 year-old girls living in communities heavily affected by poverty and HIV/AIDS in Uganda. In sub- Saharan Africa (SSA), family financial stress can compromise the support available to adolescents, with girls living in poverty exhibiting higher rates of risky sexual behavior increasing their vulnerability in acquiring HIV and other STIs. At the same time, internalizing mental health disorders such as depression and low self- esteem disproportionately affect girls and may be contributing to HIV risk behavior. Against that backdrop, support over and above health and sex education is needed to help adolescent girls in SSA successfully transition into young adulthood. The proposed study is informed by two previously tested interventions – asset- based matched savings accounts (YDA) and family strengthening through Multiple Family Groups (MFG) which have successfully been implemented with younger primary school-going adolescents. Suubi4Her will test the theory that youth cognitive and behavioral change is influenced by economic stability while examining if enhanced intra-familial support and communication are needed to maintain positive behavioral health functioning and reinforce engagement in protective health behaviors. Nested within 42 secondary schools across four districts of Uganda heavily impacted by HIV/AIDS, 1260 older girls (ages 15-17 at enrollment) will be randomly assigned (at school level) to one of three study conditions: 1) Savings (Youth Development Accounts - YDA)- with a 1:1 incentive match rate – for education and microenterprise development; 2) Savings (YDA) + MFG intervention; 3) Control condition receiving standard health and sex education provided in schools. The intervention will be provided for 24 months. Assessments at baseline,12, 24, and 36-months will include biomedical data to measure our primary sexual-risk outcome:1) proportion of girls' biologically confirmed STIs (Gonorrhea, Trichomonas and Chlamydia); and secondary outcomes: 2) the proportion of new HIV infections during the study period, and 3) for HIV+ girls, viral load and CD4 as markers of ART adherence. The study aims are to: 1) Examine whether the Suubi4Her intervention is effective in protecting adolescent girls against known HIV risk factors (including economically-motivated sex and intimate partner violence). 2) Elucidate the effects of the Suubi4Her intervention on behavioral health functioning (i.e., depression, self- efficacy and hopelessness) and examine the effects of these variables as potential mechanisms of change, mediating the relationship between each intervention and HIV risk reduction. 3) Evaluate the cost-effectiveness of each intervention condition. The study will also use the Child Depression Index and Beck Hopelessness Scale to examine the efficacy of interventions in improving mental health in this vulnerable population.

符合解决新艾滋病毒感染中分布的NIH优先事项，而UNAID呼吁 实施组合艾滋病毒预防方法，拟议的研究将检查影响和成本 与Suubi4her相关，这是一种创新的组合干预措施，旨在防止艾滋病毒风险行为 在15-17岁的女孩中，居住在乌干达贫困和艾滋病毒/艾滋病的社区中。在子中 撒哈拉非洲（SSA），家庭财务压力可能会损害青少年可用的支持，女孩 生活在贫困中，表现出较高的风险性行为，增加了他们在获取艾滋病毒方面的脆弱性 和其他性传播感染。同时，内部化精神健康障碍，例如抑郁症和自我低的人 尊重不成比例地影响女孩，可能会导致艾滋病毒风险行为。在这个背景下， 需要超越健康和性教育，以帮助SSA的青少年女孩成功地提供支持 过渡到成年。拟议的研究通过两种先前测试的干预措施（资产 - 通过多个家庭群体（MFG）基于匹配的储蓄帐户（YDA）和家庭加强 这已经成功地与年轻的小学青少年一起实施。 Suubi4her会 检验青年认知和行为改变受经济稳定的影响的理论。 如果需要增强的家庭支持和沟通来维持积极的行为健康 在保护性健康行为中发挥作用并加强参与。嵌套在42所中学 在乌干达四个地区受艾滋病毒/艾滋病的影响，有1260名年龄较大的女孩（入学人数为15-17岁） 被随机分配（在学校层面）为三个研究条件之一：1）储蓄（青年发展 帐户-YDA） - 以1：1的激励率 - 用于教育和微型企业发展； 2）储蓄 （YDA） + MFG干预； 3）控制条件接受标准健康和性教育 学校。干预措施将进行24个月。基线，12、24和36个月的评估将 包括生物医学数据来衡量我们的主要性风险结果：1）女孩在生物学上的比例 确认性传播疾病（淋病，毛毛虫和衣原体）；和次要结果：2）新的比例 研究期间的HIV感染，3）HIV+女孩，病毒载荷和CD4作为艺术依从性标志。 该研究的目的是：1）检查SUUBI4HER干预是否有效保护青少年 针对已知的艾滋病毒危险因素的女孩（包括经济动机的性别和亲密伴侣暴力）。 2） 阐明suubi4her干预对行为健康功能的影响（即抑郁，自我 效果和绝望）并将这些变量作为变化的潜在机制，将 调解每种干预措施与艾滋病毒风险降低之间的关系。 3）评估成本效益 每种干预条件。这项研究还将使用儿童抑郁指数和贝克的绝望 规模以检查干预措施在改善这一脆弱人群中的干预措施效率。