Suubi+Adherence4Youth: Optimizing the Suubi Intervention for Adherence to HIV Treatment for Youth Living with HIV in Uganda

Suubi Adherence4Youth：优化 Suubi 干预措施，以促进乌干达艾滋病毒感染青少年坚持艾滋病毒治疗

• 批准号: 10552889
• 负责人: FRED M SSEWAMALA
• 金额: $ 76.45万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10552889
• 关键词: AIDS prevention; Achievement; Address; Adherence; Adolescent; Caring; Cartoons; Clinic; Data; Economics; Effectiveness; Engineering; Enrollment; Equilibrium; Family; Foundations; Funding; Goals; HIV; HIV Infections; Health; Health Status; Health system; Incentives; Income; Infrastructure; Intervention; Intervention Studies; Kenya; Knowledge; Mediation; Mediator of activation protein; Mental Health; Methods; Modernization; Names; Outcome; Performance; Positioning Attribute; Randomized; Resources; Risk; Savings; Science; Specific qualifier value; Techniques; Testing; Training; Uganda; United States National Institutes of Health; Viral; Viral Load result; Work; Youth; aged; antiretroviral therapy; base; care outcomes; cohesion; comparative cost effectiveness; cost; cost effective; cost effectiveness; empowerment; evidence base; experience; experimental study; financial literacy; follow up assessment; geographically distant; improved; innovation; meetings; multiphase optimization strategy; prevent; primary outcome; psychosocial; response; role model; scale up; social stigma; social structure; success; theories; therapy adherence

PROJECT ABSTRACT The number of adolescents living with HIV (ALHIV) in Uganda is over 170,000 and growing. Ugandan ALHIV are a priority due to social and structural inequities that make them highly vulnerable to HIV infection and sub- optimal access and adherence to antiretroviral therapy (ART). Less than 50% of ALHIV in Uganda are ART- adherent, leading to low rates of viral suppression and high attrition from HIV care. In response to calls for expanding differentiated care approaches for ALHIV and new forms of combination HIV interventions, we seek to intervene on social and structural inequities that exacerbate the risk for viral load non-suppression. Addressing these hardships can improve ALHIV’s livelihoods and give them the knowledge and resources to sustainably manage HIV. We have shown the effectiveness of Suubi (Hope) in four NIH-funded RCTs in Uganda. Suubi is an evidence-based and theory-informed combination intervention with four components: 1) Financial Literacy Training; 2) Incentivized Matched Youth Savings Accounts with income-generating activities; 3) a manualized intervention for ART adherence and stigma reduction; and 4) Engagement with HIV treatment-experienced role models who share lived experiences of HIV. Suubi has shown robust effects on viral suppression and ART adherence, mental health and psychosocial outcomes, and family financial stability. Yet, it is unknown if each component in Suubi had a positive effect, how the components interacted, or if fewer components could have produced equivalent effects. Hence, we propose a factorial experiment to unpack and optimize Suubi to enhance scale up in health systems using the multi-phase optimization strategy (MOST). We define our “optimization objective” as the most cost-effective combination of intervention components considering three real-world constraints: 1) efficiency, 2) affordability, and 3) scalability. We then evaluate the intervention component effect sizes and balance these data against real-world information and costing data to empirically arrive at optimization. The study aims are: Aim 1. Conduct a factorial experiment (optimization trial) to test the main effects of each of the four Suubi intervention components and combinations of components (interactions) on viral suppression (primary outcome); Aim 2. Test mediators and explore moderators that explain and modify the relationship between each of the four Suubi intervention component and viral suppression; and Aim 3. Compare the cost and cost-effectiveness of each of the four Suubi intervention components and every combination of components. We will use a 24 factorial experiment with 16 conditions representing all combinations of the 4 components. Health clinics (N=48) will be randomized to 16 conditions (12 ALHIV per clinic), yielding main effects and interaction effects for the 4 components on sustained viral suppression (defined as an undetectable viral load at 12-, 24- and 36-month follow-up assessments). An optimized intervention built within real-world constraints in SSA for a high-priority group is an innovative and promising way to advance intervention science for HIV care globally.

项目摘要 乌干达感染艾滋病毒 (ALHIV) 的青少年人数超过 170,000 人，并且还在不断增加。 由于社会和结构不平等使他们极易受到艾滋病毒感染和亚健康，因此成为优先事项。 乌干达 ALHIV 患者中不到 50% 接受 ART 治疗并坚持使用。 坚持，导致病毒抑制率低，艾滋病毒护理人员流失率高。 我们寻求扩大针对 ALHIV 的差异化护理方法和新形式的艾滋病毒综合干预措施 干预加剧病毒载量无法抑制风险的社会和结构性不平等。 这些困难可以改善 ALHIV 患者的生计，并为他们提供可持续发展的知识和资源 我们在乌干达的四项 NIH 资助的随机对照试验中证明了 Suubi（Hope）的有效性。 基于证据和理论的组合干预措施由四个部分组成：1) 金融素养 培训；2) 具有创收活动的激励性匹配青年储蓄账户； 对 ART 依从性和减少耻辱进行干预；以及 4) 参与艾滋病毒治疗经历的角色； 分享艾滋病毒生活经历的模型显示出对病毒抑制和抗逆转录病毒疗法的强大作用。 然而，尚不清楚每个因素是否都存在。 Suubi 中的组件有积极的影响，组件如何相互作用，或者是否更少的组件可以产生积极的影响 因此，我们提出了一个析因实验来解压和优化 Suubi 以增强效果。 使用多阶段优化策略 (MOST) 扩大卫生系统规模 我们定义了我们的“优化”。 目标”作为考虑到三个现实世界的最具成本效益的干预成分组合 约束：1）效率，2）可负担性，3）可扩展性，然后我们评估干预成分的效果。 调整大小并将这些数据与现实世界信息和成本数据进行平衡，以凭经验实现优化。 研究目的是： 目标 1. 进行析因实验（优化试验）来检验每一项的主要效果 抑制病毒的四种 Suubi 干预成分和成分组合（相互作用） （主要结果）；目标 2. 测试调解者并探索解释和修改关系的调解者 四个 Suubi 干预成分与病毒抑制之间的关系；以及 目标 3. 比较成本和 四个 Suubi 干预组件以及每个组件组合的成本效益。 将使用 24 个因子实验，其中 16 个条件代表 4 个组件的所有组合。 诊所 (N=48) 将被随机分配到 16 种情况（每个诊所 12 种 ALHIV），产生主效应和相互作用 4 种成分对持续病毒抑制的影响（定义为 12-、24- 时检测不到的病毒载量） 以及 36 个月的后续评估）。 高优先级小组是推动全球艾滋病毒护理干预科学的一种创新且有前途的方法。