Our Family Our Future: A Resilience-oriented Family Intervention to Prevent Adolescent HIV/STI Infection and Depression in South Africa

Adolescent human immunodeficiency virus (HIV) and depression present significant public
health challenges for South Africa, a country with the largest HIV epidemic globally and
where structural factors including violence and poverty increase susceptibility for poor
mental health. In families already experiencing psychological distress, adolescents face
elevated risk for sexually transmitted infections (STIs) including HIV and depression.
Preventive interventions are urgently needed during adolescence when risks for HIV, STIs, and
depression in-crease exponentially. Preventive intervention strategies for adolescents should
substantively involve families who can tailor prevention content to meet the unique needs of
individual adolescents and reinforce formation and habituation of prevention behaviors.
Moreover, evidence indicates common family risk and protective factors for adolescent HIV/STI
risk behaviors and depression, underscoring the need for a family prevention approach.
However, key gaps exist in family prevention science. In South Africa, few empirically
supported family interventions integrate prevention of HIV/STI with depression for
adolescents. This intervention (called Our Family Our Future) uses a resilience-oriented
approach engages families in adolescent prevention from low-resource settings facing high
adversity. The study will focus on adolescents (14-16 years) who are at an ideal
developmental transition for family engagement in prevention. The age- and
developmentally-tailored intervention - called Our Family Our Future - is based off of two
empirically supported interventions that have been integrated and adapted to South Africa. In
a pilot randomized trial, Our Family Our Future exhibited outstanding acceptability,
feasibility and promising direction of effects including reductions of depressive symptoms;
lower rates of sex; decreased unprotected sex; increased HIV testing; increased knowledge,
motivation, intentions and self-efficacy for protective HIV/STI behaviors; improved family
interactions; and increased resilience. Now investigators propose the next phase of this
research program, an efficacy study of Our Family Our Future with three aims: (1) test the
efficacy of the Our Family Our Future intervention in preventing HIV/STI acquisition among
adolescents (14-16) with depressive symptoms by reducing HIV/STI risk behavior, and reducing
depressive symptoms. The project will randomize N=880 adolescents to Our Family Our Future
intervention or usual care with 6- and 12-month outcome assessments; (2) examine the extent
to which the impact of the Our Family Our Future intervention is a) mediated by changes in
resilience; behavioral skills; norms and attitudes relating to sex, condom use, gender; and
family communication and functioning and b) moderated by the effect of sociodemographics,
family HIV, and social protections; (3) identify barriers and facilitators to implementing
Our Family Our Future within a large community-based organization setting with wide reach to
provide data for future dissemination and scale-up.

Inclusion Criteria:

- 14-16 years

- adolescent concurs that the adult identified is their parent (to also include primary
caregivers in the pa-rental role)

- when more than one child in the family falls within the eligible age range, one child
will be chosen at random

- lives in the household at least 4 days a week

Exclusion Criteria:

- no or low symptoms (<8) or clinically significant thresholds of depression (16+)