Promoting Engagement in HIV Services among Adolescents in Kenya

促进肯尼亚青少年参与艾滋病毒服务

基本信息

批准号：
8728321
负责人：
Winfred K Luseno
金额：
$ 19.33万
依托单位：
PACIFIC INSTITUTE FOR RES AND EVALUATION
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-01 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8728321
关键词：
19 year old AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adolescence Adolescent Affect Africa South of the Sahara Age Area Attention Biological Markers Caring Clinic Communities Counseling Country Data Data Sources Demographic and Health Surveys Development Disease Enrollment Ethnic group Face Family Glare HIV HIV Infections HIV Seropositivity Health Health Services Accessibility Health care facility Home environment Human Resources Human immunodeficiency virus test Improve Access Individual Infection Intervention Intervention Studies Interview Joints Kenya Lead Letters Life Link Measures Medical Methods Modeling Orphan Parents Perception Physiological Policy Maker Population Prevalence Provider Province Reporting Research Research Personnel Scientist Services Staging System Testing United Nations United States National Institutes of Health Vulnerable Populations Work Youth aged base care systems compliance behavior experience high risk improved informant national surveillance neglect population based population survey pregnant programs psychosocial public health relevance research study social statistics young adult

19 year old AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adolescence Adolescent Affect Africa South of the Sahara Age Area Attention Biological Markers Caring Clinic Communities Counseling Country Data Data Sources Demographic and Health Surveys Development Disease Enrollment Ethnic group Face Family Glare HIV HIV Infections HIV Seropositivity Health Health Services Accessibility Health care facility Home environment Human Resources Human immunodeficiency virus test Improve Access Individual Infection Intervention Intervention Studies Interview Joints Kenya Lead Letters Life Link Measures Medical Methods Modeling Orphan Parents Perception Physiological Policy Maker Population Prevalence Provider Province Reporting Research Research Personnel Scientist Services Staging System Testing United Nations United States National Institutes of Health Vulnerable Populations Work Youth aged base care systems compliance behavior experience high risk improved informant national surveillance neglect population based population survey pregnant programs psychosocial public health relevance research study social statistics young adult

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项目摘要

DESCRIPTION (provided by applicant): A key obstacle in the development of effective adolescent HIV services programs is the lack of adolescent- specific HIV prevalence and service use data. Population surveys and country reports do not recognize adolescence as a distinct developmental stage; instead adolescents are grouped with young adults and called youth (i.e., 15-24 years). Available data indicate that an estimated 5 million youth are HIV infected worldwide and 75% of them live in sub-Saharan Africa. However, in contrast to young adulthood, adolescence is a period of transition characterized by major physiological, intellectual and psychosocial changes. Thus, the testing, treatment, and care needs of HIV-infected youth in mid to late adolescence (i.e., 15-19 year olds) are likely to differ substantiall from those of young adults (i.e., 20-24 years). This study focuses on adolescents because, although research indicates that this group faces a high risk of infection, inadequate attention has been paid to effective ways to identify and link the infected to care. While little is known about how to engage adolescents in HIV services, evidence suggests that available services are insufficient for this group. Few adolescents test for HIV and little is known about the proportion of adolescents in urgent need of HIV care and treatment globally receiving these services. As a group, adolescents do not routinely access provider-initiated HIV testing and counseling unless they are pregnant or in very poor health. It is not known how many youth are receiving HIV care because there are no systems that track linkage to care among those who test positive and are referred to care in Kenya. Research, however, suggests that younger infected individuals are less likely to be enrolled in care than older individuals, suggesting the need to develop more universal strategies for identification, care and treatment. The proposed study setting is Siaya District in Nyanza Province, which is the region with the highest HIV prevalence in Kenya. The Luos, comprising more than 90% of the Siaya District population, have the highest HIV and orphan prevalence of all ethnic groups in Kenya. The 2 specific study aims are: 1) To estimate HIV prevalence among Siaya District adolescents aged 15-19 years and the proportion of those infected engaged in care. Researchers will use two recent and reliable population-based data sources to estimate prevalence among Siaya adolescents and provider data to estimate the proportion receiving and adhering to HIV services. These data will provide the first credible estimate of the size of the gap between adolescents infected and those receiving care. Because the gap is expected to be large, this new information can elevate adolescent HIV care as a priority on the public agenda and serve as a baseline for intervention research. 2) To identify the obstacles and most promising strategies to identify and link HIV positive adolescents to care. Investigators will conduct qualitative interviews with key informants in at least 15 clinics with substantial experience testing and linking adolescents to care in Siaya District. They will also interview up to 80 HIV positive adolescents 15-19 years and their parent or guardian about their perceptions of barriers and possible facilitators to engagement in HIV services. This R21 research study addresses a highly vulnerable population that has been largely neglected by HIV researchers and policy makers.

描述（申请人提供）：开发有效的青少年艾滋病毒服务计划的关键障碍是缺乏青少年特定的艾滋病毒流行和服务使用数据。人口调查和国家报告不认为青春期是一个独特的发展阶段。取而代之的是，青少年与年轻人分组并被称为青年（即15-24岁）。可用的数据表明，估计有500万年轻人在全球受感染的艾滋病毒感染，其中75％居住在撒哈拉以南非洲。但是，与成年相比，青春期是一个以重大生理，智力和社会心理变化为特征的过渡时期。因此，青春期中期至后期（即15-19岁）的HIV感染青年的测试，治疗和护理需求可能与年轻人（即20-24岁）的实质性不同。这项研究的重点是青少年，因为尽管研究表明该群体面临着高感染的风险，但注意力不足，已经被注意到有效的方法来识别并将感染与护理联系起来。虽然如何使青少年参与艾滋病毒服务知之甚少，但有证据表明，可用的服务对该组不足。很少有青少年对艾滋病毒和艾滋病毒的测试对迫切需要艾滋病毒护理和治疗在全球接受这些服务的急需艾滋病毒护理和治疗的比例。作为一个小组，除非怀孕或健康状况良好，否则青少年不会常规地访问提供者发起的艾滋病毒测试和咨询。尚不知道有多少年轻人正在接受艾滋病毒护理，因为在肯尼亚的阳性人群中没有任何系统跟踪与测试阳性的人之间的联系。然而，研究表明，与老年人相比，受感染的年轻人受到护理的可能性较小，这表明需要制定更普遍的识别，护理和治疗策略。拟议的研究环境是Nyanza省的Siaya区，该地区是肯尼亚艾滋病毒患病率最高的地区。 Luos占Siaya地区人口的90％以上，在肯尼亚所有族裔群体的艾滋病毒和孤儿患病率最高。两项具体研究的目的是：1）估计15-19岁的西亚亚地区青少年的艾滋病毒患病率，以及受到护理的感染者的比例。研究人员将使用两种近期且可靠的基于人群的数据源来估计SIAYA青少年和提供商数据的流行，以估算接收和遵守HIV服务的比例。这些数据将提供第一个可靠的估计值，即受感染的青少年与接受护理人员之间差距的大小。由于预计差距将很大，因此这些新信息可以将青少年艾滋病毒护理提升为公共议程的优先事项，并作为干预研究的基准。 2）确定识别和将艾滋病毒阳性青少年照顾的障碍和最有前途的策略。调查人员将对关键线人进行定性访谈在至少15个诊所中，具有丰富经验测试并将青少年联系起来以在siAya进行护理区。他们还将面试15 - 19年的多达80名艾滋病毒阳性青少年，以及他们的父母或监护人，以了解他们对障碍的看法以及可能参与艾滋病毒服务的促进者。这项R21研究涉及一个高度脆弱的人群，该人群在很大程度上被HIV研究人员和政策制定者所忽视。