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

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.

项目概要 年轻人艾滋病毒感染者 (Y-PLWH) 抗逆转录病毒治疗的依从性和艾滋病毒参与度较差 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 中比在一般人群中更常见，并且与显着相关 与没有这些共病的 Y-PLWH 相比，对护理和治疗的依从性较差。 因此，未经治疗的抑郁症和严重的心理困扰是导致艾滋病毒结果不佳的重要原因 在这个人群中。尼日利亚是全球第四大艾滋病毒感染者和 10% 的 Y-PLWH 的居住地，但精神上 在这种情况下，不定期进行健康检查，只有不到 10% 的确诊患者能够进行健康检查 循证护理。尽管存在治疗差距，但很少有干预措施针对心理健康需求 非洲 Y-PLWH 的情况。世界卫生组织建议 Y-PLWH 的护理人员收养青少年 友好的策略并纳入心理社会服务来满足他们的需求，并且该任务转移到非 利用专门的卫生工作者来克服低收入和中等收入地区训练有素的专业人员的缺乏 国家。我们的团队和其他人已有效地使用任务转移问题解决疗法（PST）来 使用任务转移方法治疗抑郁症和心理困扰。然而，PST 是一个密集的 策略（通常每周 6-15 次会议）通常亲自交付，并且完成率较低 效率较低——在当前的 COVID-19 气候下，这一担忧进一步加剧。移动健康 技术可能特别适合克服尼日利亚有效提供 PST 的一些障碍 和新颖的基于数字游戏的策略，可用于促进心理健康干预措施的参与 在一个对年轻人有吸引力的平台上。我们的团队已经开发出一个初步原型 以理论为基础的游戏，《改变我的故事》，玩家根据不同的驱动因素来应对困难的经历 心理困扰并与虚拟环境互动以选择故事的叙事路径 结论。在这个提案中，我们将最终确定《Change My Story》的原型，并将这个游戏集成到一个 通过手机提供全面的、任务转移的 PST 干预，以优化心理参与度 卫生保健。通过R21机制，我们的目标是：1）最终确定Change My Story原型来解决关键问题 尼日利亚 Y-PLWH 心理困扰的驱动因素；2) 建立可用性、可行性和 尼日利亚患有心理困扰的 Y-PLWH 中“改变我的故事”的可接受性。通过R33 机制，我们的目标是 1）针对 80 名 Y-PLWH 开展混合实施-有效性试点 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 单独接受 PST 或接受 PST 与 Change My Story 的个人的初步效果，以及 2) 使用 实施研究综合框架（CFIR）评估影响参与的因素， 可接受性、满意度以及实施交付的促进因素和障碍。