Intensive Combination Approach to Rollback the Epidemic (iCARE) in Nigerian Adolescents

尼日利亚青少年抗击疫情的强化组合方法 (iCARE)

• 批准号: 10468148
• 负责人: Babafemi O Taiwo
• 金额: $ 132.16万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-06 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10468148
• 关键词: AIDS/HIV problem; Adolescent; Adult; Africa South of the Sahara; Age; Awareness; Blood; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Collaborations; Communities; Continuity of Patient Care; Development; Epidemic; Evidence based intervention; Feedback; Focus Groups; Gender; Goals; Government; HIV; HIV Infections; HIV Seroprevalence; Hair; Health; Hot Spot; Human immunodeficiency virus test; Incidence; Infrastructure; Institution; Intervention; Link; Literature; Measurement; Measures; Mediator of activation protein; Medical Records; Nigeria; Nigerian; Outcome; Outcome Measure; Persons; Pharmacy facility; Phase; Policies; Population; Poverty; Prevalence; Public Health; Randomized; Records; Research; Research Training; Site; Subgroup; Testing; Text Messaging; Time; United States National Institutes of Health; Universities; Viral; Viral Load result; Youth; aged; antiretroviral therapy; base; burden of illness; care outcomes; design; evidence base; experience; improved; innovation; intervention effect; mHealth; medication compliance; men who have sex with men; multidisciplinary; neglect; pediatric human immunodeficiency virus infection; peer; pilot test; pilot trial; primary outcome; programs; response; same-sex partnership; social media; social stigma; therapy adherence; therapy development; transmission process; working group; young man; young men who have sex with men

Nigeria has the 2nd highest number of people living with HIV (PLWH) and the most pediatric HIV infections globally, however, it has been neglected as a focus of public health efforts. Progress towards UNAIDS 90-90- 90 goals in Nigeria has been slow with all goals < 35%. Youth and men who have sex with men (MSM), are the weakest link in Nigeria's response to the HIV epidemic. Interventions reaching youth (including hard-to-reach MSM) and improving HIV care outcomes across the HIV care continuum should involve combination interventions as these have additive benefits compared to single interventions. In this study, we propose to build on infrastructure developed through a very successful U.S-Nigeria HIV-centered academic partnership in collaboration with partner institutions in Ibadan, Lagos and Jos, Nigeria. We will test two combination interventions among youths aged 15 to 24 years across the HIV care continuum. In the UG3 phase, we will (Aim 1) develop manualized interventions for: (a) HIV testing and linkage; and (b) HIV care outcomes among youth age 15-24 years in Ibadan using a combination approach that includes theoretically-grounded peer navigation and mHealth components. Once developed we will (Aim 2) test each combination intervention in pilot trials in Ibadan for feasibility, acceptability and initial efficacy using a pre-post design. The two interventions include: 2a) social media engagement + peer navigation to improve HIV testing and linkage to care among young MSM. The pilot test for this intervention will be considered successful if there is an increase of ≥ 30% in the number of young men completing HIV tests and an increase in the HIV incidence rate by OR=2.0 over a 48-week period compared to baseline. In addition, we will pilot test: 2b) a short message service (SMS; via adaptation of an evidence-based intervention, TXTXT) + peer navigation intervention to improve HIV care outcomes (e.g. care retention, ART adherence and viral suppression) among 40 young PLWH. This pilot intervention will be considered successful if there is ≥ 30% increase in proportion with viral load < 1000 copies/mL over a 48-week period, reflecting an effect size of OR=1.5 compared to baseline. We will also assess feasibility for measurement of medication adherence (via ART concentration in hair) and retention in care (via medical records abstraction). In the UH3 phase we will (Aim 3) demonstrate the scalability and efficacy of the two combination interventions in different HIV seroprevalence settings in Nigeria by: 3a) conducting a randomized stepped wedge trial (5 steps, 6 sites) in Ibadan, Lagos and Jos; and 3b) testing ART adherence and retention in care as mediators AND age, gender, and mode of transmission as potential moderators of the HIV care intervention effect. We hypothesize that, using the same primary outcome measures as in the UG3, the effect size of each combination intervention across and within settings, will be ≥ the effects observed in the UG3. Our goal is to develop efficacious and scalable combination intervention strategies that will accelerate UNAIDS 90/90/90 goals among Nigerian youths, including MSM.

尼日利亚艾滋病毒感染者 (PLWH) 人数位居第二，儿童艾滋病毒感染人数最多 然而，在全球范围内，它作为公共卫生工作的重点却被忽视了，联合国艾滋病规划署 90-90- 的进展。 尼日利亚的 90 个进球进展缓慢，所有进球均低于 35%。 尼日利亚应对艾滋病毒流行的最薄弱环节 向青少年（包括难以接触到的青少年）提供的干预措施。 MSM）和改善整个艾滋病毒护理连续体的艾滋病毒护理结果应结合起来 干预措施，因为与单一干预措施相比，这些干预措施具有附加效益。 建立在通过非常成功的美国-尼日利亚以艾滋病毒为中心的学术伙伴关系开发的基础设施的基础上 与尼日利亚伊巴丹、拉各斯和乔斯的合作机构合作我们将测试两种组合。 在 UG3 阶段，我们将针对 15 至 24 岁青少年进行艾滋病毒护理连续性干预。 （目标 1）制定手动干预措施：(a) 艾滋病毒检测和联系；(b) 艾滋病毒护理结果； 伊巴丹 15-24 岁的青少年采用组合方法，其中包括基于理论的同龄人 一旦开发完成，我们将（目标 2）测试每种组合干预措施。 使用前后设计在伊巴丹进行了可行性、可接受性和初步功效的试点试验。 干预措施包括： 2a) 社交媒体参与 + 同伴导航，以改善艾滋病毒检测和与 如果有增加，则该干预措施的试点测试将被视为成功。 完成艾滋病毒检测的年轻男性人数≥30%，艾滋病毒发病率增加 与基线相比，48 周内 OR=2.0 此外，我们将进行试点测试：2b) 一条短信。 服务（短信；通过基于证据的干预措施的调整，TXXTT）+同伴导航干预 改善 40 名年轻人的艾滋病毒护理结果（例如护理保留、ART 依从性和病毒抑制） 如果病毒感染比例增加 ≥ 30%，则该试点干预措施将被视为成功。 48 周内负载量 < 1000 拷贝/mL，反映出与基线相比 OR=1.5 的效应大小。 还将评估测量药物依从性的可行性（通过头发中的 ART 浓度）和 在 UH3 阶段，我们将（目标 3）展示可扩展性。 两种联合干预措施在尼日利亚不同艾滋病毒血清流行情况下的效果：3a) 在伊巴丹、拉各斯和乔斯进行随机阶梯楔形试验（5 个步骤，6 个地点）；3b) 测试 ART； 坚持和保留护理作为中介因素，年龄、性别和传播方式作为潜在因素 我们使用相同的主要结果来参与艾滋病毒护理干预效果的调节。 与 UG3 中的措施相同，跨环境和环境内每种组合干预的效果大小将 ≥ UG3 中观察到的效果我们的目标是开发有效且可扩展的组合干预措施。 将在尼日利亚青年（包括男男性行为者）中加速实施联合国艾滋病规划署 90/90/90 目标的战略。