Adaptive Strategies to Prevent and Treat Lapses of Retention in HIV Care for Adolescents (A4A)

预防和治疗青少年艾滋病毒护理中的保留失误的适应性策略 (A4A)

• 批准号: 10205178
• 负责人: Lisa Lynn Abuogi
• 金额: $ 58.82万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-25 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10205178
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Adolescent and Young Adult; Adult; Africa; Age; Appointment; Car Phone; Caregivers; Caring; Case Management; Cessation of life; Clinic; Clinical; Complex; Counseling; Development; Education; Effectiveness; Epidemic; Face; Failure; Gold; HIV; Health; Hour; Individual; Intervention; Interview; Kenya; Left; Life; Mental disorders; Methods; Monitor; Nature; Patients; Persons; Pharmacy facility; Predisposition; Provider; Psychosocial Assessment and Care; Public Health; RNA; Randomized; Resources; Schedule; Schools; Sequential Multiple Assignment Randomized Trial; Services; Structure; Telephone; Testing; Text Messaging; Time; Treatment outcome; United States National Institutes of Health; Viral; Viral Load result; Visit; Wait Time; Work; Youth; age group; aged; antiretroviral therapy; barrier to care; base; cancer therapy; cost; cost effectiveness; design; effectiveness evaluation; experience; follow-up; improved; innovation; mortality; novel strategies; outreach; patient response; peer; peer support; prevent; primary outcome; psychologic; psychosocial; relative effectiveness; response; routine care; satisfaction; sex; social; social stigma; standard of care; trial design; visit adherence

Abstract Adolescents and young adults (AYA) aged 14-24 years with HIV in Africa experience substantially higher rates of viral failure and HIV-related mortality as compared to adults. Thus, effective public health strategies tailored for and tested in this age group are urgently needed. The physical, psychological and social transitions faced by AYA create unique susceptibilities to prevalent and formidable structural (e.g., transport costs), psychosocial (e.g., the desire to fit in with peers, stigma) and clinic-based (e.g., unfriendly providers, long waiting times) barriers to engagement in public health HIV treatment settings. The variability in the intensity and the nature of barriers, however, poses a critical challenge: if barriers are highly variable, then no individual interventions are needed by all, while they also fail to help all in need. Adaptive strategies represent a novel approach to such problems with no “silver-bullet” solutions, and which we hypothesize have particular relevance for engagement of AYA in HIV treatment. Adaptive strategies typically begin with a less intensive intervention, and then escalate to a more intensive intervention only in those not doing well. Maintaining lower-intensity interventions in those doing well conserves resources in the substantial fraction of AYA who do not need additional services, thereby enabling more intensive support for those in need. While sequential multiple assignment randomized trials (SMARTs), which are used to compare different sequences of interventions, have been used to study mental illness, cancer therapy and HIV treatment, this proposal is the first to apply a SMART to address engagement of AYA in HIV treatment in Africa. Within this design, we will use developmentally appropriate interventions with high potential for effectiveness that will be tailored by AYA pre-implementation. Specifically, we will randomize 880 AYA with HIV in Kenya to either (1) youth-centered education & counseling (standard of care) vs. (2) addition of a SMS and peer electronic navigator who provides support, information and counseling via phone. Those with a lapse in engagement will be re-randomized a second time to one of three higher-intensity re- engagement interventions: (1) standard of care outreach and intensified counseling, (2) conditional cash transfers and (3) in-person peer navigation. The primary outcome will be a combination of visit adherence and viral load suppression. This study will quantify the relative effectiveness (and cost effectiveness) of several strategies composed of promising individual interventions. We will assess provider and patient experiences and satisfaction with the interventions using mixed methods. This innovative study will offer relevant evidence for public health programming to end the AIDS epidemic for AYA with HIV.

抽象的 非洲 14-24 岁的青少年和年轻人 (AYA) 感染艾滋病毒的经历显着 与成人相比，病毒失败率和艾滋病毒相关死亡率更高。 迫切需要针对这个年龄组量身定制并进行测试的健康策略。 AYA 面临的心理和社会转变对流行和社会问题产生了独特的敏感性。 巨大的结构性（例如交通成本）、心理社会性（例如与同龄人相处的愿望、 耻辱）和基于诊所（例如不友好的提供者、漫长的等待时间）的参与障碍 公共卫生艾滋病毒治疗环境的强度和性质的可变性， 然而，这提出了一个严峻的挑战：如果障碍变化很大，那么就没有单独的干预措施 所有人都需要，但它们也无法帮助所有有需要的人。适应性策略代表了一种新颖的策略。 解决此类问题没有“银弹”解决方案，但我们有 AYA 参与艾滋病毒治疗的特别相关性通常是从适应性策略开始的。 进行强度较低的干预，然后仅针对那些情况升级为强度较大的干预 对表现不佳的国家维持较低强度的干预措施可以节省资源。 很大一部分 AYA 不需要额外的服务，从而实现更多服务 同时为有需要的人提供大力支持。 （SMART）用于比较不同的干预措施序列，已被用于 研究精神疾病、癌症治疗和HIV治疗，该提案是第一个应用SMART的提案 为了解决 AYA 参与非洲艾滋病毒治疗的问题，我们将使用。 适合发展的干预措施，具有很高的有效性潜力，将量身定制 具体来说，我们将肯尼亚的 880 名艾滋病毒 AYA 随机分配到其中之一。 (1) 以青少年为中心的教育和咨询（护理标准）与 (2) 添加短信和同伴 通过电话提供支持、信息和咨询的电子导航员。 参与度下降将第二次重新随机分配到三个更高强度的重新分配之一 参与干预措施：(1) 标准护理外展和强化咨询，(2) 有条件现金转移和 (3) 面对面的同行导航 主要成果将是 这项研究将结合访问依从性和病毒载量抑制来量化相对值。 由有前途的个人组成的几种策略的有效性（和成本效益） 我们将评估提供者和患者的体验以及对干预措施的满意度。 这项创新研究将为公众提供相关证据。 为感染艾滋病毒的 AYA 制定结束艾滋病流行的健康计划。