Adolescent research has generated a rigorous body of evidence on how family processes influence young people's HIV-prevention and sexual reproductive health (SRH) behaviors through family communication, positive parent-child relationships, and parental monitoring. Peer group interventions have also shown promise in reducing stigma among HIV+ adults in sub-Sahara Africa (SSA) and in supporting adolescent self- management of chronic illnesses. Despite this evidence, most HIV treatment programs serving adolescents living with HIV (ALHIV) in SSA are clinic-based and focused on medical outcomes with few resources available to address the social, familial and stigmatized context in which ALHIV live. The need for effective interventions to support adolescent HIV self-management is particularly pressing in SSA where the majority of the 2.1 million ALHIV reside. Highlighting the vulnerability of ALHIV is their increasing HIV-related mortality, up 50% in 2012 compared to 2005, while the global number of HIV-related deaths among all ages decreased by 30%. In response to the disparate burden of HIV mortality among ALHIV, combined with the compelling evidence from HIV prevention and chronic illness literature and research on the influential role of families, we propose to refine and pilot test an ALHIV/caregiver group intervention. This intervention will draw upon principles of Positive Youth Development (PYD) and Social Cognitive theory (SCT) to emphasize skills building, self- efficacy, youth participation, and strengthening adult relationships. The intervention will build upon an existing ALHIV support group guide and utilize trained facilitators to hold group sessions with ALHIV and their caregivers to: 1) improve understanding of HIV among ALHIV and caregivers;2) help ALHIV develop strategies for healthy living including adherence to ART;3) build the capacity of ALHIV to make informed decisions about their sexual and reproductive health;4) build the capacity of caregivers to support ALHIV;and 5) help ALHIV develop life skills to communicate their HIV diagnosis effectively, and to plan for their future. The study design has two phases. The first phase is the refinement of the ALHIV/caregiver intervention manual followed by a second phase feasibility pilot study. Our goals are to refine and pilot a feasible intervention tha fosters resiliency and draws upon the strengths of adolescents and their families.
Specific aims i nclude to: (1) Refine activities and an intervention manual for a family-focused group intervention for adolescents and their caregivers to improve HIV self-management among adolescents living with HIV;(2) conduct a pilot study to assess the acceptability and feasibility f the group intervention among 50 adolescent/caregiver pairs that are randomly assigned to the intervention or the comparison arms, and (sub aim 2a) examine preliminary trends in outcome measures, including ART adherence, safer sex behaviors and stigma, comparing the intervention and comparison study arms.
The proposed study will refine and pilot test an adolescent/caregiver intervention to promote HIV self- management among adolescents living with HIV (ALHIV) in Zambia. The intervention seeks to shift HIV care practices for ALHIV from a focus on individual medical outcomes to one that incorporates families and emphasizes skills building, self-efficacy, youth participation and the strengthening of adult and family relationship. Findings will provide the basis for future intervention studies to test the impact of a family-base approach on the HIV self-management behaviors and health outcomes among this understudied population.