Our Family Our Future: Family Prevention of HIV Risk and Depression in HIV-endemic South Africa

Brief Summary

Detailed Description

The Our Family Our Future Program is a preventive intervention program designed to prevent or reduce adolescent sexual risk behavior and to increase mental health resilience against depression onset among adolescents (13-15 years of age). The intervention takes a family approach and addresses HIV risk and depression in an integrated model. HIV and depression are the leading causes of global burden of disease in low and middle income countries. The intervention is being tested in South Africa, the country confronting the largest HIV epidemic in the world and because preliminary studies with South African families identified poor mental health and sexual risk behavior as priority areas for preventive intervention development and testing. This study is a randomized pilot design, where 152 adolescents and parents will be randomly assigned to an intervention condition or a standard usual care condition and then offered the experimental intervention as on a wait-list. Families will be recruited and screened for eligibility based on systematic house-to-house recruitment in the community. Eligibility is based on dyadic eligibility and includes age criteria, consistent presence in the household, depressive symptoms that fall below clinically significant threshold criteria, and ability to provide informed consent and assent. Eligible families will be randomized and offered a preventive intervention program in a group format, led by program facilitators in a community setting. The intervention program consists of 3 sessions plus an individualized family meeting. In some modules parents/guardians/caregivers and adolescents will have content delivered together and in some modules parents/guardians/caregivers and adolescents will break out to adult-only or adolescent-only groups. The overall objective of study is to assess the following study questions: Question 1: Is this study feasible? Question 2: Is this intervention acceptable to the target population? Question 3: Is there preliminary evidence of hypothesized effects of the intervention, that the intervention will reduce or maintaining symptoms that fall below the clinically significant range for depression and reduce or delay actual or intended sexual risk behavior in adolescents? The study takes a single blind, randomized pilot trial. The study takes a secondary prevention approach. The investigators collect three sets of data. First, the investigators assess feasibility by examining recruitment rates, attendance, completion, and drop-out rates, and fidelity. Second, the investigators assess acceptability by examining satisfaction data. Third, as a secondary aim, the investigators use pilot data to assess hypothesized intervention effects by examining outcomes at baseline, immediately post-intervention (2-4 weeks after the last intervention session is completed), and at four months.

Primary Outcomes

Secondary Outcomes

• Change in depression impairment from baseline to 4 months post-intervention as measured through DISP and CPODMV(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in HIV knowledge from baseline to 4 months post-intervention as measured through the HIV Knowledge Questionnaire(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in perceived HIV risk susceptibility from baseline to 4 months post-intervention using a ranking derived from a 0-100 and as measured on a likert scale response(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in norms and attitudes about condoms from baseline to 4 months post-intervention as measured through the condom attitudes scale and likert response questions(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in sexual behavior self-efficacy from baseline to 4 months post-interventionusing a ranking derived from a 0-100 and as measured on a likert scale response(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in anxiety from baseline to 4 months post-interventionas measured through BAI and RCMAS(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in trauma symptoms from baseline to 4 months post-intervention as measured through PCL and NSESSS(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in family relationship from baseline to 4 months post-intervention as measured through Family Relationship Scale(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in family relationship from baseline to 4 months post-intervention as measured through the Inventory of Parent-peer Attachment(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in parenting from baseline to 4 months post-intervention as measured through the Parenting Scale(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in resilience from baseline to 4 months post-intervention as measured through CD-RISC(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in HIV stigma from baseline to 4 months post-intervention as measured through the HIV Knowledge Questionnaire(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in norms and attitudes about sex from baseline to 4 months post-intervention as measured on a likert scale response(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in psychological distress from baseline to 4 months post-intervention as measured through K6 and SDQ(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in hope from baseline to 4 months post-intervention as measured through BHS(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in social support from baseline to 4 months post-intervention as measured through MSPSS(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in family communication from baseline to 4 months post-intervention as measured through the Parent-adolescent Communication Scale(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in family communication from baseline to 4 months post-intervention as measured through the Parent-adolescent Sex Communication Scale(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in substance use from baseline to 4 months post-intervention as measured through AUDIT and DUDIT(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)
• Change in parenting from baseline to 4 months post-interventionas measured through the Parental Monitoring Questionnaire(assessed at baseline, starting within 2-4 weeks of intervention end, and 4 months post-intervention)