HIV risk and depression among families in HIV-endemic South Africa present significant public health challenges to a country with the largest HIV epidemic globally. In these families, adolescents face elevated risk for HIV and depression. Furthermore, their adult caregivers (biological or surrogate parents) are also at escalated risk fo depression. Growing evidence indicates family risk and protective factors for HIV risk behaviors and depression, underscoring the need for a family prevention approach. However, key gaps exist in family prevention science in HIV-endemic communities. Few existing family preventions target HIV risk and depression in one integrated model;emphasize a resilience based approach;and are adapted to South Africa. The scientific objective of this K01 is to integrate two empirically supported models for HIV risk (Keepin'It Real) and depression (Family Talk) into a unified family preventive intervention appropriate for South Africa and test initial acceptabilit and feasibility. The training objective of this K01 is to obtain intensive mentored training that wll prepare the PI to become a leading researcher on family preventive interventions for sexual and mental health resilience among children and caregivers in HIV-endemic communities. Training develops expertise in family preventive intervention approaches;builds skills to adapt preventive interventions to South Africa and standardize into a manual;develops expertise in preventive intervention design and implementation with a focus on RCT study designs;and builds statistical and analytical skills in assessment of protocol adherence, treatment fidelity and acceptability, mechanism measurement, and trial efficacy. Training is linked to three study aims.
Aim 1 is to integrate two existing preventive interventions for HIV risk and depression into a unified model and adapt the content and language to be appropriate for South Africa.
Aim 1 will be accomplished through focus groups with caregivers (18+ years) and adolescents (13-15 years) and interviews with mental and HIV prevention experts, community leaders, and practitioners.
Aim 2 standardizes the preventive intervention into a manual and trains facilitators Aim 3 assesses feasibility regarding recruitment and retention and acceptability of the intervention.
Aim 3 will be accomplished with randomization of 124 caregiver- adolescent dyads (n=62 dyads in the preventive intervention group, n=62 dyads in the control group) and assessments at baseline, immediately post-intervention, and three months post-intervention. Findings inform future plans for preventive intervention testing in a fully-powered RCT. The study advances NIMH priorities by 1) improving effectiveness of mental health services for HIV-affected families;2) developing interventions to prevent HIV-infection and to improve adherence to health protective behaviors in adolescents;3) developing age, language, and culture-appropriate programs;and 4) promoting multidisciplinary research and training on mental health of HIV-affected minority communities. The study fills a significant gap in family prevention science in a high risk population and setting.

Public Health Relevance

Growing evidence of HIV risk and depression among adolescents and their caregivers in HIV-endemic South Africa indicates an urgent need for public health research that protects health resilience among families in these settings. Family factors linked to caregiver and adolescent HIV risk behavior and depression justify a family prevention approach. This study addresses a key gap in prevention science for HIV-endemic communities by adapting, standardizing, and demonstrating initial feasibility and acceptability of a contextually appropriate family prevention model for HIV risk behavior and depression.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Scientist Development Award - Research & Training (K01)
Project #
Application #
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Pequegnat, Willo
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Brown University
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
Meinck, Franziska; Cluver, Lucie Dale; Orkin, Frederick Mark et al. (2017) Pathways From Family Disadvantage via Abusive Parenting and Caregiver Mental Health to Adolescent Health Risks in South Africa. J Adolesc Health 60:57-64
Gamarel, Kristi E; Kuo, Caroline; Boyes, Mark E et al. (2017) The dyadic effects of HIV stigma on the mental health of children and their parents in South Africa. J HIV AIDS Soc Serv 16:351-366
Pellowski, Jennifer A; Barnett, Whitney; Kuo, Caroline C et al. (2017) Investigating tangible and mental resources as predictors of perceived household food insecurity during pregnancy among women in a South African birth cohort study. Soc Sci Med 187:76-84
Maughan-Brown, Brendan; Smith, Philip; Kuo, Caroline et al. (2017) Readiness for Antiretroviral Therapy: Implications for Linking HIV-Infected Individuals to Care and Treatment. AIDS Behav :
Donald, Kirsten A M; Fernandez, Anne; Claborn, Kasey et al. (2017) The developmental effects of HIV and alcohol: a comparison of gestational outcomes among babies from South African communities with high prevalence of HIV and alcohol use. AIDS Res Ther 14:28
Thomas, Eileen; Kuo, Caroline; Cohen, Sophie et al. (2017) Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study. Prev Med 102:100-111
Maughan-Brown, Brendan; Kuo, Caroline; Galárraga, Omar et al. (2017) Stumbling Blocks at the Clinic: Experiences of Seeking HIV Treatment and Care in South Africa. AIDS Behav :
Kuo, Caroline; Atujuna, Millicent; Mathews, Catherine et al. (2016) Developing family interventions for adolescent HIV prevention in South Africa. AIDS Care 28 Suppl 1:106-10
Phillips, Nicole; Amos, Taryn; Kuo, Caroline et al. (2016) HIV-Associated Cognitive Impairment in Perinatally Infected Children: A Meta-analysis. Pediatrics 138:
Becker, Elisabeth; Kuo, Caroline; Operario, Don et al. (2015) Measuring child awareness for adult symptomatic HIV using a verbal assessment tool: concordance between adult-child dyads on adult HIV-associated symptoms and illnesses. Sex Transm Infect 91:528-33

Showing the most recent 10 out of 30 publications