Growing Up: Intervening with HIV-Positive Adolescents in Resource-Poor Settings

成长：在资源匮乏的环境中对艾滋病毒阳性青少年进行干预

基本信息

批准号：
8993596
负责人：
JESSY G DEVIEUX
金额：
$ 19.9万
依托单位：
FLORIDA INTERNATIONAL 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：
2015-08-25 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8993596
关键词：
15 year old 19 year old AIDS prevention AIDS/HIV problem Adherence Adolescence Adolescent Adult Affect Africa South of the Sahara Anti-Retroviral Agents Antiretroviral resistance Back Behavior Behavior Therapy Behavioral CD4 Lymphocyte Count Caregivers Caribbean region Caring Child Childhood Chronic Disease Clinic Clinical Cognitive Cognitive Therapy Communication Country Data Development Developmental Delay Disorders Diagnosis Disease Distress Economics Education Educational workshop Elements Epidemic Evidence based intervention Exposure to Failure Focus Groups Goals HIV HIV Infections HIV Seropositivity HIV risk HIV-infected adolescents Haiti Health Health Care Costs Health Personnel Health Promotion Incidence Income Inferior Intervention Interview Joints Learning Life Low income Manuals Measures Methods Modeling Monitor Moods Morbidity - disease rate Motivation Outcome Parents Patients Perinatal Population Population Study Prevalence Preventive Procedures Protocols documentation Psychometrics Psychosocial Assessment and Care Psychosocial Factor Randomized Controlled Trials Recruitment Activity Regimen Reporting Reproductive Health Research Resources Risk Risk Behaviors Risk Reduction Role Services Severities Sex Behavior Sexual Partners Stress Testing Training Translating Treatment Cost Treatment outcome Unsafe Sex Viral Load result Work Youth antiretroviral therapy arm base cohort cost evidence base experience improved information model innovation mortality pediatric human immunodeficiency virus pediatric human immunodeficiency virus infection preference programs psychological distress public health relevance response scale up skills skills training therapy adherence transmission process treatment adherence trial comparing

项目摘要

DESCRIPTION (provided by applicant): As pediatric HIV infection has shifted from being a fatal disease to a chronic illness, a growing cohort of young people are moving through adolescence with all the challenges of the adult HIV-infected population but largely without comparable treatment outcomes or an evidence base to improve adherence to antiretroviral treatment (ART) and preventive behavior. Despite overall declines in HIV incidence and mortality since the ART scale-up, both have risen among youth. The goal of the proposed 3-year R34 developmental study is to respond to this need for tailored research, in particular among HIV+ older adolescents, and contribute to understanding the added value in resource-limited settings of including caregivers in an adherence and risk reduction program. Although caregiver involvement is a recognized correlate of outcomes in HIV+ youth, there are no rigorous studies of the role of caregivers in outcomes among HIV+ older adolescents. This project will integrate caregiver involvement and cognitive behavioral intervention (CBI) elements to improve ART adherence and HIV risk reduction for HIV+ older adolescents treated in resource-poor clinical settings. Our proposed study population will include caregivers and 15 to 19 year-old HIV+ youth who know their status and are receiving ART in Port-au-Prince, Haiti. Guided by the theoretical framework of the developmentally sensitive Information-Motivation-Behavioral Skills for Pediatric Adherence (IMB-PED), we will develop Growing Up (N'ap Grandi, in Haitian Creole) as a collaborative model of caregiver-adolescent engagement in the key informational, motivational, and behavioral skills antecedents of ART adherence and risk reduction. The proposed study partners with Haiti's largest youth health provider, FOSREF, and builds upon prior work with HIV+ youth and adults in Port-au-Prince. The study will utilize qualitative and quantitative methods to: identify barriers and facilitators to adherence and risk reduction (Aim 1); develop and pretest N'ap Grandi, including developmentally-appropriate manuals, training materials, procedures, and psychometric adequacy of measures (Aim 2); and assess feasibility and preliminary efficacy in a 3-arm randomized controlled trial (RCT), in which 120 youth will be assigned to three groups: the experimental caregiver-adolescent N'ap Grandi, an adolescent-only version (N'ap Grandi-A) and an adolescent-only health promotion group (HP-A), examining ART adherence and virologic response, HIV risk behaviors, positive communication and monitoring, stress and mood, and costs from the health center perspective (Aim 3). Isolation, inhibited communication, caregiver distress, adolescent ART non-adherence and HIV risk are very high in Haiti, which is a microcosm of the global pediatric HIV epidemic in low and middle income countries (LMICs) with generalized epidemics. After sub- Saharan Africa, the Caribbean is the most HIV-affected region in the world, with 50% of people with HIV infection living in Haiti. Our proposed study will be the first tailored intervention and RCT pilotd for HIV+ adolescents in Haiti, and will represent one of only a handful in LMICs globally.

描述（由申请人提供）：随着儿科艾滋病毒感染已从一种致命疾病转变为一种慢性疾病，越来越多的年轻人正在经历青春期，面临着成人艾滋病毒感染者的所有挑战，但基本上没有可比的治疗结果或提高抗逆转录病毒治疗 (ART) 依从性和预防行为的证据基础尽管自 ART 推广以来，艾滋病毒发病率和死亡率总体下降，但青年人的 3 年 R34 发展目标却有所上升。这项研究的目的是满足这种定制研究的需求，特别是在艾滋病毒+老年青少年中，并有助于了解在资源有限的环境中将护理人员纳入依从性和降低风险计划的附加价值，尽管护理人员的参与被认为与结果相关。在艾滋病毒+青少年中，目前还没有关于照顾者对艾滋病毒+老年青少年的影响的严格研究。该项目将整合照顾者的参与和认知行为干预（CBI）要素，以提高接受资源治疗的艾滋病毒+老年青少年的抗逆转录病毒治疗依从性并降低艾滋病毒风险。 - 临床环境较差。我们提议的研究人群将包括海地太子港的护理人员和 15 至 19 岁的艾滋病病毒感染者，他们了解自己的状况并正在接受抗逆转录病毒治疗，以儿科发展敏感的信息-动机-行为技能的理论框架为指导。依从性 (IMB-PED)，我们将开发成长（N'ap Grandi，海地克里奥尔语）作为看护者与青少年在关键信息、激励和拟议的研究与海地最大的青少年健康服务提供商 FOSREF 合作，并以之前在太子港开展的艾滋病毒阳性青少年和成人工作为基础。该研究将利用定性和定量方法：确定并促进遵守和降低风险（目标 1）；开发和预测试 N'ap Grandi，包括适合发展的手册、培训材料、程序和心理测量措施的充分性（目标2)；并评估三组随机对照试验 (RCT) 的可行性和初步效果，其中 120 名青少年将被分配到三组：实验看护者青少年 N'ap Grandi，仅限青少年版本 (N' ap Grandi-A）和青少年健康促进小组（HP-A），从健康中心的角度检查 ART 依从性和病毒学反应、艾滋病毒风险行为、积极沟通和监测、压力和情绪以及成本（目标 3）。海地的隔离、沟通受阻、照顾者的痛苦、青少年不遵守抗逆转录病毒治疗和艾滋病毒风险非常高，这是继撒哈拉以南非洲地区之后，中低收入国家（LMIC）全球儿童艾滋病毒流行的一个缩影。加勒比地区是世界上受艾滋病毒影响最严重的地区，50% 的艾滋病毒感染者生活在海地，我们提出的研究将是海地首个针对艾滋病毒阳性青少年进行的定制干预和随机对照试验。将是全球少数中低收入国家之一。