Suubi-Mhealth: A mobile health intervention to address depression and improve ART adherence among Youth living with HIV (YLHIV) in Uganda

Suubi-Mhealth：一种移动健康干预措施，旨在解决乌干达艾滋病毒感染者 (YLHIV) 青少年的抑郁症问题并提高抗逆转录病毒疗法的依从性

• 批准号: 10701072
• 负责人: Patricia A Cavazos-Rehg
• 金额: $ 17.13万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-08 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10701072
• 关键词: 15 year old; Address; Adherence; Adolescent; Adult; Africa South of the Sahara; Age; Behavior Therapy; Caregivers; Cellular Phone; Child; Clinic; Clinical; Cognitive Therapy; Control Groups; Depressed mood; Development; Drops; Evaluation; Evidence based intervention; Feedback; Focus Groups; Goals; HIV; HIV Infections; Health; Health Personnel; Intervention; Interview; Lead; Letters; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methodology; Methods; Mobile Health Application; Outcome; Persons; Phase; Practical Robust Implementation and Sustainability Model; Prevalence; Protocols documentation; Public Health; Quality of life; Research; Resource-limited setting; Risk; Sampling; Signal Transduction; Site; Specific qualifier value; Structure; Subgroup; Testing; Therapeutic Intervention; Time; Uganda; United States National Institutes of Health; Waiting Lists; Work; Youth; acceptability and feasibility; active method; antiretroviral therapy; behavioral health; comorbidity; depressive symptoms; digital treatment; evidence base; experience; health care settings; improved; innovation; intervention effect; intervention refinement; low and middle-income countries; mHealth; mobile application; pilot test; post intervention; primary outcome; programs; recruit; response; secondary outcome; social stigma; success; therapy adherence; tool; transmission process; treatment adherence; user centered design; young adult

PROJECT ABSTRACT Approximately 1.7 million children under 15 years old were living with HIV in 2020; and most new HIV infections (85%) occurred in Sub-Saharan Africa (SSA). People living with HIV (PLHIV) often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. However, 76% to 85% of PLHIV in SSA receive no treatment for serious mental health disorders, especially depression. Depression reduces ART adherence, which negatively impacts health and increases HIV transmission risks. Older adolescents (≥14 years) living with HIV are particularly vulnerable to these risks as caregivers withdraw or lessen their support during their transition to young adulthood. Moreover, older adolescents are also moving into larger and less accommodating adult HIV clinic settings and are at risk for dropping out of ART programs. Given that mental health services are severely under equipped in SSA, including in Uganda, and are inaccessible by many YLHIV, new solutions to increase access to mental health care and close the treatment gap are urgently needed. The overall goal of this proposed R21/33 study is to develop an mHealth intervention (Suubi-mhealth) for use among Ugandan youth (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. This digital therapy intervention delivered via a mobile application, will utilize the core tenets of cognitive-behavioral therapy (CBT) found to improve depression and ART adherence. The proposed study will specifically: Phase 1. R21 Aim 1: Develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand needs of youth living with HIV (YLHIV). We will conduct four focus groups with youth and two focus groups with health care providers (6-8 youth each) for feedback on intervention content and methods to increase participation and retention. R21 Aim 2: Based on results of Aim 1, explore the feasibility and acceptability subsequent refinement for the larger R33 phase. Phase of Suubi-Mhealth on a small scale (N=30), to inform 2. R33 Aim 1: Test the preliminary impact of Suubi- Mhealth versus a waitlist control group (N=200), on youth outcomes (depression, ART adherence, mental health functioning, quality of life, stigma). R33 Aim 2: Examine barriers and facilitators for integrating Suubi-Mhealth into health care settings for YLHIV. The study will be conducted in 10 health clinics in the greater Masaka region in Southern Uganda. We expect for Suubi-Mhealth to be an acceptable and feasible mHealth tool to reduce depression, improve ART adherence and overall mental health functioning among YLHIV. If the results of this pilot are promising, then the next step is an R01 to rigorously test Suubi-Mhealth in a larger trial, spanning multiple sites across Uganda.

项目摘要 2020年，大约有170万15岁以下的儿童患有艾滋病毒；和大多数新的艾滋病毒感染 （85％）发生在撒哈拉以南非洲（SSA）。患有艾滋病毒（PLHIV）的人经常在心理健康上挣扎 降低其抗逆转录病毒疗法（ART）依从性的合并症。但是，SSA中有76％至85％的PLHIV 不接受严重的心理健康障碍，尤其是抑郁症的治疗方法。抑郁症减少了艺术 依从性，会对健康产生负面影响并增加HIV传播风险。年长的青少年（≥14岁） 艾滋病毒感染特别容易受到这些风险的影响，因为护理人员退出或更少的支持 他们过渡到年轻成年。此外，年长的青少年也正在进入更大和更少的 参加成人艾滋病毒诊所环境，有可能退出艺术计划的风险。考虑到那种精神 SSA的医疗服务严重不足，包括在乌干达，并且许多YLHIV无法访问， 迫切需要新的解决方案，以增加获得精神卫生保健的机会并缩小治疗差距。这 这项拟议的R21/33研究的总体目标是开发MHealth干预措施（Suubi-Mhealth） 乌干达青年（14-17岁）患有艾滋病毒和抑郁症，考虑到他们独特的上下文， 文化和发展需求。通过移动应用程序提供的这种数字疗法干预措施将 利用认知行为疗法（CBT）的核心宗旨可改善抑郁和艺术依从性。 拟议的研究将专门：第1阶段。R21AIM 1：开发并迭代地完善干预措施 基于形成性工作的Suubi-Mhealth方案，以了解艾滋病毒（YLHIV）青年的需求。我们 将与青年和两个焦点小组与医疗保健提供者（每个6-8名青年）一起举办四个焦点小组 关于干预内容和增加参与和保留的方法的反馈。 R21 AIM 2：基于 AIM 1的结果，探索可行性和可接受性 随后对较大R33期的细化。阶段 Suubi-Mhealth的小规模（n = 30），以告知 2。R33AIM 1：测试Suubi的初步影响 MHealth与候补名单对照组（n = 200），关于青年结果（抑郁，艺术依从性，心理健康 功能，生活质量，污名）。 R33 AIM 2：检查整合Suubi-Mhealth的障碍和促进者 进入YLHIV的医疗保健环境。该研究将在大马萨卡地区的10个卫生诊所进行 在乌干达南部。我们希望Suubi-Mhealth成为可接受且可行的MHealth工具 抑郁症，改善YLHIV之间的艺术依从性和整体心理健康功能。如果结果的结果 飞行员很有希望，然后下一步是在较大的试验中严格测试Suubi-Mhealth的R01 乌干达的多个地点。