An interactive, narrative intervention to address the mental health treatment gap among young people living with HIV in Nigeria

一种互动式叙事干预措施，旨在解决尼日利亚艾滋病毒感染者年轻人的心理健康治疗差距

• 批准号: 10914342
• 负责人: Aimalohi Ahonkhai
• 金额: --
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-14 至 2023-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10914342
• 关键词: Address; Adherence; Adolescent; Adopted; Africa; Africa South of the Sahara; African; Appointment; COVID-19; Caregivers; Caring; Cause of Death; Cellular Phone; Climate; Clinic; Consolidated Framework for Implementation Research; Country; Development; Diagnosis; Disease remission; Distress; Effectiveness; Emotional; Epidemiology; Exploratory/Developmental Grant; Friends; Funding Opportunities; Future; General Population; Goals; HIV; Health; Health Professional; Health Promotion; Health Services Accessibility; Health Technology; Home; Individual; Interdisciplinary Study; Intervention; Knowledge; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Nigeria; Nonprofit Organizations; Outcome; Ownership; Patients; Persons; Play; Population; Provider; Psychiatric Social Work; Psychotherapy; Public Health; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Role; Side; Social Impacts; Technology; Testing; Therapeutic Intervention; Training; Treatment outcome; Universities; Visit; World Health Organization; Youth; acceptability and feasibility; age group; antiretroviral therapy; care providers; comorbidity; cost; design; digital; disorder control; effectiveness-implementation RCT; effectiveness/implementation hybrid; epidemic response; evidence base; experience; handheld mobile device; implementation barriers; implementation science; improved; innovation; interest; intervention delivery; low and middle-income countries; mHealth; medication compliance; mental training; multidisciplinary; novel; problem solving therapy; prototype; psychologic; psychological distress; satisfaction; screening; social cognitive theory; social stigma; stakeholder perspectives; telephone based; theories; usability; virtual environment; Address; Adherence; Adolescent; Adopted; Africa; Africa South of the Sahara; African; Appointment; COVID-19; Caregivers; Caring; Cause of Death; Cellular Phone; Climate; Clinic; Consolidated Framework for Implementation Research; Country; Development; Diagnosis; Disease remission; Distress; Effectiveness; Emotional; Epidemiology; Exploratory/Developmental Grant; Friends; Funding Opportunities; Future; General Population; Goals; HIV; Health; Health Professional; Health Promotion; Health Services Accessibility; Health Technology; Home; Individual; Interdisciplinary Study; Intervention; Knowledge; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Nigeria; Nonprofit Organizations; Outcome; Ownership; Patients; Persons; Play; Population; Provider; Psychiatric Social Work; Psychotherapy; Public Health; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Role; Side; Social Impacts; Technology; Testing; Therapeutic Intervention; Training; Treatment outcome; Universities; Visit; World Health Organization; Youth; acceptability and feasibility; age group; antiretroviral therapy; care providers; comorbidity; cost; design; digital; disorder control; effectiveness-implementation RCT; effectiveness/implementation hybrid; epidemic response; evidence base; experience; handheld mobile device; implementation barriers; implementation science; improved; innovation; interest; intervention delivery; low and middle-income countries; mHealth; medication compliance; mental training; multidisciplinary; novel; problem solving therapy; prototype; psychologic; psychological distress; satisfaction; screening; social cognitive theory; social stigma; stakeholder perspectives; telephone based; theories; usability; virtual environment

PROJECT SUMMARY Young people living with HIV (Y-PLWH) have poor adherence to antiretroviral therapy and engagement in HIV care, making HIV the leading cause of death for African adolescents. Depression and psychological distress are much more common among Y-PLWH than in the general population, and are associated with significantly worse adherence to care and treatment when compared to Y-PLWH without these co-morbid conditions. Thus, untreated depression and severe psychological distress are important contributors to poor HIV outcomes in this population. Nigeria is home to the 4th largest HIV population globally and 10% of Y-PLWH, but mental health screening is not routinely conducted in this setting, and less than 10% of those diagnosed have access to evidence-based care. Despite this treatment gap, few interventions have targeted the mental health needs of Y-PLWH in Africa. The World Health Organization recommends that caregivers of Y-PLWH adopt youth- friendly strategies and incorporate psychosocial services to meet their needs, and that task shifting to non- specialized health workers be used to overcome the dearth of trained professionals in low and middle-income countries. Task-shifted problem Solving Therapy (PST) has been effectively used by our team and others to treat both depression and psychological distress using a task-shifted approach. However, PST is an intensive strategy (typically 6-15 weekly sessions) often delivered in-person and poor completion rates are associated with less effectiveness -- a concern further magnified during the current COVID-19 climate. Mobile health technologies may be uniquely suited to surmount some of the obstacles for effective PST delivery in Nigeria and novel digital game-based strategies, can be utilized to promote engagement in mental health interventions on a platform that is compelling for young people. Our team has developed, a preliminary prototype of a theory-grounded game, Change My Story, in which players navigate difficult experiences based on drivers of psychological distress and interact with a virtual environment to choose a narrative path toward the story's conclusion. In this proposal, we will finalize the prototype of Change My Story, and integrate this game into a comprehensive, task-shifted PST intervention delivered via mobile phone to optimize engagement in mental health care. Through the R21 mechanism, we aim to: 1) finalize the Change My Story prototype to address key drivers of psychological distress among Y-PLWH in Nigeria and 2) establish the usability, feasibility, and acceptability of Change My Story among Y-PLWH with psychological distress in Nigeria. Through the R33 mechanism, we aim to 1) conduct a hybrid implementation-effectiveness pilot RCT for 80 Y-PLWH with depression or psychological distress, and compare feasibility, acceptability, engagement, satisfaction and preliminary effectiveness among individuals receiving PST alone or PST with Change My Story, and 2) use the Consolidated Framework for Implementation Research (CFIR) to assess factors influencing engagement, acceptability, and satisfaction along with facilitators and barriers to implementation delivery.

项目摘要 艾滋病毒（Y-PLWH）的年轻人坚持抗逆转录病毒疗法和参与艾滋病毒 护理，使艾滋病毒成为非洲青少年死亡的主要原因。抑郁和心理困扰 在Y-PLWH中比一般人群更普遍，并且与 与Y-PLWH相比，在没有这些合并条件的情况下，对护理和治疗的依从性较差。 因此，未经治疗的抑郁和严重的心理困扰是造成较差艾滋病毒结果的重要因素 在这个人群中。尼日利亚是全球第四大艾滋病毒人群的所在地，占Y-PLWH的10％，但心理 在这种情况下，没有常规进行健康筛查，不到10％的诊断者可以使用 进行循证护理。尽管存在这种治疗差距，但很少有干预措施针对心理健康需求 非洲的Y-Plwh。世界卫生组织建议Y-PLWH的护理人员采用青年 - 友好的策略并纳入心理社会服务以满足他们的需求，并将其转移到非 - 专业卫生工作者被用来克服低收入和中等收入的训练有素的专业人员的缺乏 国家。我们的团队和其他人有效地使用了任务切换的解决问题疗法（PST） 使用任务转移方法治疗抑郁症和心理困扰。但是，PST是一个密集型 策略（通常每周6-15次会议）通常是亲自交付的，并且完成率较差 有效性较小 - 这是当前共同199气候期间进一步放大的问题。移动健康 技术可能非常适合克服尼日利亚有效交付的一些障碍 和新颖的基于数字游戏的策略可以用于促进参与心理健康干预措施 在一个对年轻人引人入胜的平台上。我们的团队开发了一个初步的原型 理论上的游戏，改变我的故事，玩家在这种情况下在基于驾驶员的驾驶员的艰难经历中导航 心理困扰并与虚拟环境互动，以选择通往故事的叙事道路 结论。在此提案中，我们将最终确定改变故事的原型，并将该游戏集成到一个 通过手机提供的全面，任务迁移的PST干预措施，以优化参与精神 卫生保健。通过R21机制，我们的目标是：1）最终确定我的故事原型的更改以解决密钥 尼日利亚Y-PLWH的心理困扰驱动因素和2）确定可用性，可行性和 在尼日利亚的心理困扰中，在Y-PLWH中改变我的故事的可接受性。通过R33 机制，我们的目的是1）对80 y-plwh进行混合实施效应pilot RCT 抑郁或心理困扰，并比较可行性，可接受性，参与度，满意度和 单独接收PST或与我的故事更改的个人之间的初步有效性，2）使用 合并实施研究框架（CFIR）评估影响参与的因素， 可接受性和满意度以及实施交付的促进者和障碍。