INTEGRATING A TRANSDIAGNOSTIC PSYCHOLOGICAL INTERVENTION IN THE CARE FOR ADOLESCENTS AND YOUTH WITH HIV IN KENYA

将跨诊断心理干预纳入肯尼亚艾滋病毒感染青少年的护理中

• 批准号: 10675988
• 负责人: Pamela Y Collins
• 金额: $ 52.8万
• 依托单位: UNIVERSITY OF NAIROBI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675988
• 关键词: AIDS prevention; Address; Adolescence; Adolescent; Adoption; Adult; Affect; Africa South of the Sahara; Age; Anxiety; Caring; Clinic; Clinic Visits; Clinical; Cluster randomized trial; Cognitive; Cognitive Therapy; Collaborations; Competence; Data; Development; Diagnostic; Disease Progression; Effectiveness; Elements; Frequencies; Funding; Future; Guidelines; HIV; HIV-infected adolescents; Health; Health Personnel; Health Services Accessibility; Health system; Hybrids; Improve Access; Income; Individual; International; Intervention; Kenya; Length; Low income; Maintenance; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Neuropsychology; Outcome; Patients; Persons; Pilot Projects; Policy Maker; Population; Problem Solving; Procedures; Process; Provider; Psychosocial Assessment and Care; Randomized, Controlled Trials; Recommendation; Relaxation; Research; Research Personnel; Schools; Services; Specialist; Stretching; Supervision; Symptoms; System; Telephone; Time; Training; Trauma; Treatment outcome; United States; Viral; Youth; antiretroviral therapy; anxiety symptoms; clinically significant; comorbidity; coping; cost; depressive symptoms; economic evaluation; effectiveness evaluation; effectiveness outcome; effectiveness testing; follow-up; high risk; implementation barriers; implementation context; implementation cost; implementation determinants; implementation intervention; implementation measures; implementation outcomes; implementation process; implementation/effectiveness; improved; innovation; low and middle-income countries; mental training; psychoeducation; psychoeducational; psychologic; psychological distress; psychological symptom; reduce symptoms; routine care; satisfaction; scale up; screening; secondary outcome; skills; standard of care; successful intervention; symptomatology; trauma symptom; uptake

Project Summary/Abstract Depression, anxiety, and trauma are common mental disorders that disproportionately affect adolescents and youth with HIV (AYHIV), and are associated with antiretroviral treatment (ART) non-adherence and poor treatment outcomes. The integration of mental health services in HIV care for AYHIV is recommended, but is lacking due to few trained mental health providers, and lack of a well validated integration models. Transdiagnostic interventions based on cognitive behavioral therapy (CBT) and delivered by lay health workers are effective in addressing these mental health conditions and could potentially improve HIV treatment outcomes. Barriers to integration of these interventions in the care of AYHIV in sub-Saharan Africa include paucity of effectiveness data among AYHIV and the lack of adaptation to tailor implementation for the HIV care context, including the length of treatment (number and frequency of sessions) and the format of delivery. This proposal builds on the successful pilot of Psychoeducation, Relaxation, PrOblem solving, Activation, Cognitive coping (PRO-ACT), a brief, modular and transdiagnostic intervention for adolescents and youth with mild to moderate symptoms of depression and anxiety in Kenya that resulted in clinically significant reduction in symptoms. The intervention can be delivered in stand-alone modules either in person or by phone, making it particularly appropriate for AYHIV when school is in session. In this project, we propose to further adapt PRO- ACT for the HIV care setting through a stakeholder engagement process with policymakers, mental health and adolescent HIV practitioners, and AYHIV. To prepare for the execution of trial, the stakeholders will identify and prioritize potential barriers to implementation and suggest adaptations to the implementation process that address key barriers. A pilot study at an HIV clinic with 10 providers and 20 AYHIV with mild to moderate symptoms will enable the study team to further adapt the intervention and study procedures. Using a hybrid 1 cluster randomized trial in 30 HIV clinics in Kenya, we will assess the effectiveness of PRO-ACT in reducing depressive, anxiety and trauma symptoms 6 months and 12 months after enrolment, comparing 300 AYHIV with mild to moderate symptoms in intervention to 300 in control clinics. To inform the integration of the intervention in routine care, we will measure implementation outcomes including reach, fidelity and maintenance, and explore multilevel determinants influencing reach, fidelity and maintenance in mental health screening and management, acceptability of training by providers and satisfaction with services by AYHIV. We will also conduct an economic evaluation through a time-driven activity- activities within the 30 clinics in participating in the study to estimate the implementation costs from a patient and health system perspective.

项目摘要/摘要 抑郁，焦虑和创伤是常见的精神障碍，对青少年和 艾滋病毒（AYHIV）的青年，与抗逆转录病毒治疗（ART）不遵守和差有关 治疗结果。建议将心理健康服务在艾滋病毒的艾滋病毒护理中的整合，但是 由于训练有素的心理健康提供者缺乏，缺乏良好的集成模型。 基于认知行为疗法（CBT）的经诊断干预措施，并由外行健康工作者提供 有效解决这些心理健康状况，并有可能改善HIV治疗结果。 在撒哈拉以南非洲的AYHIV护理中整合这些干预措施的障碍包括 AYHIV之间的有效性数据以及缺乏适应艾滋病毒护理环境实施的量身定制的数据， 包括治疗时间（会话的数量和频率）和交付格式。这个建议 建立在成功的心理教育，放松，解决问题，激活，认知应对的基础上 （亲切），对青少年和温和的青年进行简短，模块化和经诊断的干预措施 肯尼亚的中度抑郁症和焦虑症状导致临床上显着减少 症状。干预措施可以亲自或通过电话进行独立模块进行，使其 上学时特别适合Ayhiv。在这个项目中，我们建议进一步适应 通过与决策者，心理健康和 青少年艾滋病毒从业者和ayhiv。为了为执行审判做准备，利益相关者将确定并 优先考虑实施的潜在障碍，并建议适应实施过程 解决关键障碍。在HIV诊所进行的一项试点研究，有10个提供者和20个AYHIV轻度至中度的AYHIV 症状将使研究团队能够进一步适应干预和研究程序。使用混合动力1 在肯尼亚的30个HIV诊所的聚类随机试验，我们将评估亲实践在降低的有效性 抑郁，焦虑和创伤症状在入学后6个月零12个月，比较300 AYHIV与 在控制诊所中，干预中的轻度至中度症状。告知干预的整合 在日常护理中，我们将衡量实施成果，包括覆盖范围，忠诚度和维护，并探索 多层次的决定因素影响覆盖范围，忠诚度和心理健康筛查和管理中的维护， 提供者对培训的可接受性和对服务的满意度。我们还将进行经济 通过时间驱动的活动活动进行评估 30个参与研究的诊所，以估计患者和卫生系统的实施成本 看法。