Hope for the Future: A School-Based HIV Prevention Program for Youth in Malawi

未来的希望：马拉维青年学校艾滋病毒预防计划

• 批准号: 7670337
• 负责人: ABIGAIL KAZEMBE
• 金额: $ 5.18万
• 依托单位: KAMUZU COLLEGE OF NURSING
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7670337
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adolescence; Adolescent; Adult; Affect; Age; Automobile Driving; Behavior; Behavioral; Cognitive; Communities; Consequences of HIV; Contracts; Country; Critiques; Data; Decision Making; Development; Educational Curriculum; Effectiveness; Epidemic; Evaluation; Exhibits; Experimental Designs; Family; Female; Focus Groups; Fostering; Friends; Future; Gender; Goals; Group Interviews; HIV; HIV Infections; Health; Health Knowledge, Attitudes, Practice; High Prevalence; Hour; Impulsivity; Intervention; Interview; Knowledge; Lead; Learning; Life; Malawi; Male Adolescents; Manuals; Mass Media; Measures; Media Campaign; Mentors; Parents; Participant; Peer Group; Peer Pressure; Phase; Poverty; Prevalence; Prevention; Prevention program; Preventive Intervention; Procedures; Process; Prostitution; Protocols documentation; Questionnaires; Reporting; Research; Research Design; Research Priority; Risk; Risk Behaviors; Risk Reduction; Risk-Taking; Rural; Rural Community; Schools; Secondary Schools; Secure; Self Efficacy; Sexual Abstinence; Sexual Maturation; Southern Africa; Structure; Students; Surveys; Teenagers; Testing; Time; Vision; Woman; Work; Youth; aged; base; boys; condoms; cost; design; effective intervention; emerging adult; experience; follow-up; girls; high risk sexual behavior; innovation; intervention program; male; meetings; men; peer; post intervention; pressure; prevent; programs; public health relevance; research study; resilience; safer sex; sex; sexual debut; sexually active; social; social cognitive theory; success; theories; transmission process; trend

DESCRIPTION (provided by applicant): The major goal of this research is to develop, implement, and assess the effectiveness of Hope for the Future, an innovative intervention specifically tailored for adolescents attending rural community secondary schools in Malawi -- a country with one of the highest HIV prevalence rates in the world. Based on an integration of 3 theories (Social Cognitive Behavior Theory, The Theory of Possible Selves, and Resilience Theory) and findings from the PI's dissertation, the intervention is designed to give Malawi adolescents the hope and confidence that through their own acts they can avoid contracting HIV or live a long and productive life if already infected. The intervention will be delivered in seven 2-hour sessions after school to mixed-gender groups consisting of 16 students (8 male and 8 female). The study design consists of 4 phases. Phase I (Aim 1) will survey and in-depth interview male youth ages 15 to 17 about sexual decision-making and their knowledge, attitudes, and behavior relevant to HIV AIDS. These data will be analyzed and compared with matching findings for girls from the PI's dissertation research conducted at the same 7 schools in Malawi's Lilongwe Rural West District. Phase II (Aim 2) will develop a working draft of the intervention's curricula and facilitators' manual prior to pre-testing for feasibility and acceptability. A Community Advisory Group, the PI's mentors, and six focus groups of youth will critique the program's intervention sessions and learning modules to assure that they are culturally sensitive, developmentally appropriate, and relevant for secondary school adolescents. In Phase III (Aim 3) the revised intervention will be pilot tested at 2 community secondary day schools. Process evaluation will assess fidelity to the intervention's protocols. A semi-structured questionnaire will be developed, pre- tested, and used with the groups at base-line and 2 months post-intervention to assess program feasibility and acceptability, identify possible trends related to change among students, conduct final power calculations, and to assess the success of the study's recruitment and follow-up procedures. Phase IV (Aim 4) will test the intervention on 528 students at 12 schools (6 treatment; 6 control) using a quasi-experimental design with pretest-post-test measures at base-line and again at two month follow-up. Compared to students receiving the standard HIV prevention curriculum (control condition) at 2 months post-intervention, students participating in the Hope for the Future intervention are expected to be: (1) More confident that they can achieve their life goals; (2) Less likelihood to have experienced sexual debut; and (3) More likely to report being abstinent in the last two months. They also are expected to have: (4) greater perceived self-efficacy to abstain from sex if desired; (5) greater perceived self-efficacy to practice safer sex when sexually active; and (6) greater likelihood to report having used condoms consistently in the last two months if sexually active. If proved effective, the intervention will offer a cost-effective strategy for HIV prevention among school youth that can be rolled out-countrywide in Malawi and in the southern Africa region. PUBLIC HEALTH RELEVANCE: Malawi has one of the highest HIV prevalence rates in the world, particularly among youth ages 15-23. Using a quasi-experimental design with pre and post-intervention measures, this research is designed to develop, implement and assess the effectiveness of Hope for the Future, a seven session school-based intervention specifically tailored to Malawian adolescents attending rural community secondary schools. If this innovative approach to HIV prevention for young people can be documented to be effective, it offers a cost-effective strategy for HIV prevention that can be rolled out countrywide and in the southern Africa region.

描述（由申请人提供）：这项研究的主要目标是开发，实施和评估对未来希望的有效性，这是一种专门针对马拉维农村社区中学的青少年量身定制的创新干预措施，这是世界上最高的HIV患病率之一。基于3种理论的整合（社会认知行为理论，可能的自我理论和韧性理论）以及PI论文的发现，该干预措施旨在使马拉维青少年的希望和信心通过自己的行为，他们可以通过自己的行为避免收缩艾滋病毒或过着长期和富有生产力的生活。这项干预措施将在放学后的七个2小时课程中分配给由16名学生（8名男性和8位女性）组成的混合性别群体。研究设计包括4个阶段。第一阶段（AIM 1）将调查15至17岁的男性对性决策及其知识，态度和与艾滋病毒艾滋病相关的行为的调查和深入访谈。这些数据将进行分析，并将其与在马拉维·莉隆韦乡村地区同一7所学校进行的PI论文研究的女孩的匹配发现进行了比较。 II阶段（AIM 2）将在预先测试之前制定干预课程和促进者手册的工作草案，以确保可行性和可接受性。一个社区咨询小组，PI的导师和六个青年焦点小组将批评该计划的干预课程和学习模块，以确保他们对文化敏感，发展适合且与中学青少年相关。在第三阶段（AIM 3）中，修订后的干预措施将在2个社区中期学校进行试点测试。过程评估将评估干预协议的忠诚度。将在基础线和干预后2个月与小组一起开发，预先测试和使用半结构化问卷，以评估计划的可行性和可接受性，确定与学生变化相关的可能趋势，进行最终的权力计算，并评估研究的招聘和随访程序的成功。第四阶段（AIM 4）将使用准实验性设计对528名学校（6次治疗; 6个对照）的528名学生进行干预，并在基础线上进行预测试测试，并在两个月的随访中再次进行。与在干预后2个月接受标准艾滋病毒预防课程（控制条件）的学生相比，参加未来干预的希望的学生预计将是：（1）更有信心，他们可以实现自己的生活目标； （2）不太可能经历过性行为的可能性； （3）在过去两个月中更有可能报告戒酒。他们还应该有：（4）如果需要的话，更有意识到的自我效能感以弃权； （5）在性活跃时，更有意识到的自我效能是实行更安全的性行为； （6）如果性活跃，在过去两个月中，报告使用避孕套的可能性更大。如果证明有效，干预措施将为学校青年预防艾滋病毒的艾滋病毒预防策略，可以在马拉维和南部非洲地区范围内范围内范围内进行。公共卫生相关性：马拉维是世界上最高的HIV患病率之一，尤其是在15-23岁的青年中。这项研究旨在使用前后干预措施的准实验设计，旨在开发，实施和评估未来希望的有效性，这是一项七个会议的基于学校的干预措施，专门针对就读于农村社区中学的马拉维青少年量身定制。如果可以将这种预防艾滋病毒预防的创新方法记录在有效的情况下，它为预防艾滋病毒的预防提供了一种经济有效的策略，可以在全国范围内和南部非洲地区推出。