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.

项目概要/摘要 抑郁、焦虑和创伤是常见的精神障碍，对青少年和青少年的影响尤为严重。 感染艾滋病毒 (AYHIV) 的青少年，并与抗逆转录病毒治疗 (ART) 不依从性和不良相关 治疗结果。建议将心理健康服务纳入针对 AYHIV 的 HIV 护理中，但 由于缺乏训练有素的心理健康服务提供者，并且缺乏经过充分验证的整合模型。 基于认知行为疗法 (CBT) 并由非专业卫生工作者提供的跨诊断干预措施 可以有效解决这些心理健康问题，并可能改善艾滋病毒治疗结果。 将这些干预措施纳入撒哈拉以南非洲地区 AYHIV 护理的障碍包括缺乏 AYHIV 的有效性数据以及缺乏针对艾滋病毒护理环境调整实施的适应性， 包括治疗时间（疗程次数和频率）和治疗方式。这个提议 建立在心理教育、放松、问题解决、激活、认知应对的成功试点之上 (PRO-ACT)，一种针对轻度至青少年的简短、模块化和跨诊断干预措施 肯尼亚的中度抑郁和焦虑症状导致临床上显着减少 症状。干预可以通过亲自或通过电话以独立模块的形式进行，从而使其 特别适合学校上课期间的 AYHIV。在这个项目中，我们建议进一步采用PRO- 通过利益相关者与政策制定者、心理健康和 青少年艾滋病毒从业者和 AYHIV。为了准备试验的执行，利益相关者将确定并 优先考虑实施的潜在障碍，并建议对实施过程进行调整 解决关键障碍。在 HIV 诊所进行的一项试点研究，有 10 名提供者和 20 名轻度至中度 AYHIV 感染者 症状将使研究团队能够进一步调整干预和研究程序。使用混合动力 1 在肯尼亚 30 个艾滋病诊所进行的整群随机试验中，我们将评估 PRO-ACT 在减少艾滋病毒感染方面的有效性 入组后 6 个月和 12 个月的抑郁、焦虑和创伤症状，将 300 名 AYHIV 患者与 在对照诊所中干预了 300 名轻度至中度症状。告知干预措施的整合 在日常护理中，我们将衡量实施结果，包括覆盖范围、保真度和维护，并探索 影响心理健康筛查和管理的范围、保真度和维持的多层次决定因素， 对提供者培训的接受程度以及对 AYHIV 服务的满意度。我们还将开展经济 通过时间驱动的活动进行评估——范围内的活动 30 家诊所参与了这项研究，以估算患者和卫生系统的实施成本 看法。