Data-informed Stepped Care (DiSC) to Improve Adolescent HIV Outcomes

以数据为依据的分级护理 (DiSC) 可改善青少年艾滋病毒治疗结果

• 批准号: 9923276
• 负责人: Grace John-Stewart
• 金额: $ 15.36万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9923276
• 关键词: Acceleration; Adherence; Adolescent; Adopted; Adult; Age; Alcohol or Other Drugs use; Anti-Retroviral Agents; Behavioral; Caregiver support; Caregivers; Caring; Childhood; Client; Client satisfaction; Clinic; Clinical; Cluster randomized trial; Committee Members; Communities; Computerized Medical Record; Consent; Continuity of Patient Care; Data; Decision Making; Development; Educational workshop; Effectiveness; Enrollment; Ethics; Ethics Committees; Failure; Family; Focus Groups; Frequencies; Group Interviews; HIV; HIV Seropositivity; HIV-infected adolescents; Health Personnel; Health Promotion; Health Services; Health Services Research; High Prevalence; Intensive Care; Intervention; Kenya; Lawyers; Medical Records; Mental Health Services; Modeling; Outcome; Patients; Pharmacy facility; Policies; Policy Maker; Population; Prospective cohort; Public Health; Records; Research; Resources; Risk; Services; Standardization; Student Dropouts; Surveys; Treatment Protocols; Treatment outcome; Viral; Visit; Wait Time; Work; Workload; Youth; age group; base; care outcomes; cofactor; cohort; experience; follow-up; high risk; improved; improved outcome; innovation; multidisciplinary; peer support; primary outcome; programs; recruit; secondary outcome; social; standard of care; therapy development; tool; treatment as usual; virology

PROJECT SUMMARY/ABSTRACT Adolescents (ages 10-19) experience disproportionately low retention, antiretroviral (ART) adherence and viral suppression compared to other age groups. HIV care programs in high prevalence, resource-limited settings have developed innovative approaches to improve linkage, retention and viral suppression, including simplified treatment regimens, task-shifting, and peer support. However, clear policies and practices for enrolling adolescents in HIV services and research, as well as systematic strategies that identify adolescents who need more intensive care to successfully achieve key milestones along the HIV care continuum, are lacking. ‘Stepped care’ approaches, where the most at-risk clients receive increasing levels of intensity and frequency of care, have been used to target interventions and efficiently use resources. A clinical prediction tool using standardized risk scores can help healthcare providers to identify adolescents at greater risk of experiencing negative outcomes and direct interventional support to them. Our data-informed stepped care (DiSC) intervention pairs stepped care with a clinical prediction tool to optimize limited resources and improve HIV care and treatment outcomes. Our team, which has worked with pediatric and adult HIV programs in Kenya for over two decades, including an established repertoire of adolescent HIV studies, proposes to implement this combination data- driven intervention using a stepped care model to inform public health decision-making and improve adolescent HIV care in Kenya. Formative work in UG3 will include establishment of a clinic-based prospect cohort of adolescents ages 10-19 and their care givers at 6 high volume HIV clinics in Western Kenya. Based on data derived from surveys and abstraction of electronic medical records, we will determine key predictors of loss to care and suspected virologic failure, and develop a clinical prediction tool to identify adolescents needing more intensive support. We will conduct focus groups and interviews to understand and optimize adolescent consent and representative participation in HIV care and research. This work, including adolescent and community stakeholder perspectives, will inform development and optimization of the DiSC intervention for adolescent HIV treatment management in UH3. DiSC will be evaluated through a cluster randomized trial at 20 high-volume HIV clinics, looking at both effectiveness (6 and 12-month retention, viral suppression, ART adherence) and implementation outcomes (feasibility and acceptability). These aims have potential to provide a generalizable, systematic approach to deliver differentiated adolescent HIV care that integrates with diverse HIV care programs and available support options to accelerate progress toward achieving the 90-90-90 targets for adolescents.

项目摘要/摘要 青少年（10-19岁）经历低保留率不成比例的，抗逆转录病毒（ART）依从性和病毒 与其他年龄组相比，抑制作用。高流行，资源有限设置的HIV护理计划 已经开发了创新的方法来改善联系，保留和病毒抑制，包括简化 治疗方案，任务转移和同伴支持。但是，明确的政策和实践 艾滋病毒服务和研究的青少年，以及确定需要的青少年的系统策略 缺乏更重症监护，以成功地达到艾滋病毒护理连续体的关键里程碑。 ‘走了 护理的方法，最高风险的客户获得越来越高的强度和护理频率的方法， 已用于针对干预措施并有效使用资源。使用标准化的临床预测工具 风险评分可以帮助医疗保健提供者确定具有更大风险的青少年 结果和直接介入的支持。我们的数据信息阶梯护理（DISC）干预对 使用临床预测工具进行护理，以优化有限的资源并改善HIV护理和治疗 结果。我们的团队与肯尼亚的儿科和成人艾滋病毒计划合作二十年了， 包括既定的青少年艾滋病毒研究库，实施此组合数据的提案 - 使用阶梯护理模型驱动干预，以告知公共卫生决策并改善青少年 肯尼亚的艾滋病毒护理。 UG3中的形成性工作将包括建立基于诊所的前景队列 10-19岁的青少年及其在肯尼亚西部6个高批量艾滋病毒诊所的护理人员。基于数据 我们将从调查和电子病历的抽象中得出，我们将确定损失损失的关键预测指标 护理和怀疑的病毒衰竭，并开发临床预测工具来识别青少年需要更多 密集支持。我们将进行焦点小组和访谈以了解和优化青少年同意 代表参与艾滋病毒护理和研究。这项工作，包括青少年和社区 利益相关者的观点将为青少年艾滋病毒的椎间盘干预提供信息和优化 UH3中的治疗管理。光盘将通过20个高体积HIV的簇随机试验进行评估 诊所，研究有效性（6个月和12个月保留，病毒抑制，艺术依从性）和 实施结果（可行性和可接受性）。这些目标有可能提供可概括的， 提供差异化​​的青少年艾滋病毒护理的系统方法 以及可用的支持选项，以加速进步，以实现青少年的90-90-90目标。