Improving Adherence Among HIV+ Rwandan Youth: A TI-CBTe Indigenous Leader Model

提高艾滋病毒卢旺达青年的依从性：TI-CBTe 土著领袖模型

• 批准号: 8978312
• 负责人: Mardge H Cohen
• 金额: $ 46.52万
• 依托单位: HEKTOEN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8978312
• 关键词: 21 year old; 6 year old; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Adolescent and Young Adult; Adult; Africa South of the Sahara; Age; Anti-Retroviral Agents; Attitude; Caregiver support; Caregivers; Caring; Clinic; Cognitive Therapy; Comorbidity; Complex; Country; Data; Distress; Economics; Ensure; Epidemic; Evidence based intervention; Face; Feeling hopeless; Forcible intercourse; Future; Gender Role; Goals; HIV; Health; Health Priorities; Indigenous; Infection; Intervention; Left; Life; Life Expectancy; Link; Logistics; Measurement; Mediator of activation protein; Medical center; Medicine; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Noise; Outcome; Parents; Participant; Patient Self-Report; Perinatal; Pharmaceutical Preparations; Population; Prevalence; Productivity; Provider; Psychologist; Psychosocial Assessment and Care; Quality of life; Randomized; Reporting; Research; Research Infrastructure; Resources; Rwanda; Services; Sex Behavior; Site; Survivors; Target Populations; Techniques; Testing; Time; Training; Trauma; Treatment outcome; Viral; Viral Load result; Virus; Woman; Youth; antiretroviral therapy; arm; base; behavioral study; comparative efficacy; experience; follow-up; gender-based violence; global health; improved; innovation; medication compliance; meetings; mortality; multidisciplinary; outreach; pill; programs; resistant strain; role model; sexual violence; transmission process; treatment as usual; treatment strategy

DESCRIPTION (provided by applicant): Like most of sub-Saharan Africa, Rwandan youth are the epicenter of the AIDS epidemic, accounting for 40% of new infections. Antiretroviral (ART) adherence is a global health priority, but Rwandan youth are more than twice as likely to be on second line therapy as adults, and with a median population age of 18.7 years old, adherence is essential for Rwanda's future. Resources to provide youth-centered medical and psychosocial care are limited in Rwanda, and young people with HIV face many obstacles to adherence, namely the long-term consequences of genocide, depression, and gender-based violence, as well as logistical issues, negative attitudes, and insufficient parent/caregiver support. Preliminary data underscore the utility of culturally-adapted, trauma-informed cognitive behavioral therapy (TI-CBT) in reducing depression and traumatic distress among youth and adults in Rwanda. This project proposes a 2-arm RCT to test and compare the efficacy of adherence-enhanced TI-CBT (i.e., TI-CBTe) to usual care in increasing ART adherence among 350 Rwandan 14 - 21 year olds from the two clinics caring for the largest number of youth with HIV in Rwanda. Based on the Indigenous Leader Outreach Model, we will train 20 HIV+ indigenous youth leaders who are > 95% ART adherent (IYL) and supervising psychologists to deliver the intervention. Youth, caregivers, and IYL will complete baseline, 6-, and 12-month follow-up assessments to assess effects on adherence and important mediators (trauma, depression, gender-based violence). We will use an intent-to-treat analysis and a combination of regression techniques and other inferential statistical tests for contrasting means and proportions. We will analyze treatment outcomes using logistic and linear multiple regression models examining effects at 6- and 12- months separately, as well as a combined model with random effects for repeated measurements across time. This proposal answers a compelling need for innovative programs to increase ART adherence among HIV+ youth. If effective, the study will build Rwanda's capacity to provide much needed services; and, involvement by the Rwanda Biomedical Center will ensure wide dissemination.

描述（由申请人提供）：像大多数撒哈拉以南非洲一样，卢旺达青年是艾滋病流行病的中心，占新感染的40％。抗逆转录病毒（ART）依从性是全球健康的重中之重，但卢旺达青年的二线治疗的可能性是成年人的两倍以上，并且中位数18.7岁的人口年龄为18.7岁，这对于卢旺达的未来至关重要。在卢旺达，提供以青年为中心的医学和社会心理护理的资源受到限制，艾滋病毒的年轻人面临许多依从性的障碍，即种族灭绝，抑郁症和基于性别的暴力以及后勤问题，负面态度以及不足的父母/照顾者的支持。初步数据强调了在卢旺达的青年和成人中减少抑郁症和创伤性困扰的文化适应性，具有创伤性的认知行为疗法（TI-CBT）的实用性。该项目提出了一个2臂RCT，以测试和比较依从性增强的Ti-CBT（即Ti-CBTE）的疗效，以在350名卢旺达的350岁诊所中增加艺术依从性，从而增加两家诊所的艺术依从性，从而使兰斯达艾滋病毒年轻人最多。根据土著领导人的外展模式，我们将培训20名艾滋病毒+土著青年领袖，他们的艺术依附者（IYL）> 95％，并监督心理学家进行干预。青年，看护人和IYL将完成基线，6个月和12个月的随访评估，以评估对依从性和重要调解者的影响（创伤，抑郁症，基于性别的暴力）。我们将使用意图对治疗分析以及回归技术和其他推论统计测试的组合，以进行对比手段和比例。我们将使用逻辑和线性多元回归模型分别检查6个月和12个月的效果，以及具有随机效应的合并模型，以随机重复测量。该提案回答了对创新计划的迫切需求，以增加艾滋病毒+青年的艺术依从性。如果有效，这项研究将建立卢旺达提供急需服务的能力；而且，卢旺达生物医学中心的参与将确保广泛的传播。