Developing/Testing a Multi-level Interventions (SHIELD & IWC)

开发/测试多层次干预措施（SHIELD

• 批准号: 10227304
• 负责人: SUJHA SUBRAMANIAN
• 金额: $ 147.26万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 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 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227304
• 关键词: Address; Adherence; Adolescent; Adopted; Adult; Advocate; Affect; Age; Antiviral Agents; Behavior Therapy; Budgets; Caring; Cervical Cancer Screening; Childhood; Clinic; Clinical; Communities; Community Health Systems; Comprehensive Health Care; Continuity of Patient Care; Data Collection; Development; Economics; Ensure; Environment; Face; Family; Feedback; Female Adolescents; Goals; Government; Guidelines; HIV; HIV Seronegativity; HIV Seropositivity; Health; Health system; Healthcare; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human immunodeficiency virus test; Incidence; Individual; Infection; Integrated Delivery of Health Care; International; Intervention; Interview; Knowledge; Learning Module; Malignant neoplasm of cervix uteri; North Carolina; Phase; Pilot Projects; Population; Prevention; Preventive service; Privacy; Procedures; Process; Randomized; Reproductive Health; Reproductive Health Services; Research; Sampling; Self Efficacy; Service delivery model; Services; Sexual Health; Social support; Source; Structure; Testing; Training; Treatment Protocols; Universities; Update; Viral Load result; Youth; Zambia; aged; antiretroviral therapy; base; cost effectiveness; design; experience; experimental study; family support; girls; high-risk adolescents; instrument; older women; peer; peer support; pre-exposure prophylaxis; preference; recruit; scale up; screening program; service delivery; social; social stigma; success; young woman

PROJECT SUMMARY/ABSTRACT Zambia has one of the highest incidences of HIV in the world, and adolescent girls and young women (AGYW) are particularly affected. Prior studies and initiatives attempted to provide youth-friendly services through adolescent antiretroviral therapy (ART) clinics that offer a range of services, but these clinics have faced challenges because loss of privacy and the stigma associated with HIV. To address this gap, the Zambian Ministry of Health, RTI International, the Population Council, and the University of North Carolina are collaborating to create an integrated wellness care (IWC) delivery model that targets all HIV-affected AGYW, both those that are HIV negative or do not know their status (HIV-/u) and those that are HIV positive (HIV+). We will test a multilevel package of interventions to connect AGYW with a source of regular care to provide a sustainable platform for successful implementation of regular HIV testing and support for linkage to care, retention in care, and adherence to antiviral treatment. We propose to pursue the following aims: UG3–1. Engage stakeholders by establishing community and youth advisory boards, conduct formative research, adapt modules for behavioral intervention, and develop data collection instruments. UG3–2. Recruit AGYW to establish a sampling frame and perform a discrete choice experiment to systematically evaluate preferences for HIV clinic-based services (1,000 HIV-/u AGYW aged 10 to 20 years and 800 HIV+ AGYW aged 16 to 24 years) to ensure the IWC clinic is tailored to AGYW's needs. UG3–3. Develop standard operating procedures (SOPs) for IWC clinic service delivery and structure, identify and train IWC clinic staff, engage the Youth Advisory Board to create a youth-friendly environment, and conduct a pilot study to evaluate implementation processes (25 AGYW). UH3–1. Assess efficacy at 6 and 12 months of the multilevel interventions at the individual (HIV knowledge, self-efficacy), interpersonal (social support, stigma reduction), and health system (IWC clinic) levels on HIV testing, retention in care, and viral load suppression using a cluster randomized design. UH3–2. Conduct in-depth interviews with clinical staff and peer navigators at 12 months to obtain feedback on the integrated care delivery model to assess sustainability, document best practices, and update SOPs to support scaling up of integrated services for AGYW. UH3–3. Perform cost-effectiveness and budget analysis to evaluate and describe impact along the HIV care continuum and disseminate findings to national partners and the international community. This integrated service delivery model, if successful, can also serve as a platform to implement additional preventive services, including pre-exposure prophylaxis (PrEP) for high-risk AGYW, which is currently under consideration by the government.

项目概要/摘要 赞比亚是世界上艾滋病毒发病率最高的国家之一，少女和年轻妇女 (AGYW) 受到的影响尤其严重，此前试图提供青年友好型服务的研究和举措。 通过提供一系列服务的青少年抗逆转录病毒治疗 (ART) 诊所，但这些诊所 由于失去隐私和与艾滋病毒相关的耻辱，面临着挑战。为了解决这一差距， 赞比亚卫生部、RTI International、人口理事会和北卡罗来纳大学 正在合作创建一个针对所有艾滋病毒感染者的综合健康护理 (IWC) 提供模式 AGYW，HIV 阴性或不知道自己的状况 (HIV-/u) 和 HIV 阳性的人 （HIV+）我们将测试一套多层次的干预措施，将 AGYW 与定期护理来源联系起来 为成功实施定期艾滋病毒检测提供可持续的平台并支持与 我们建议实现以下目标： UG3-1. 通过建立社区和青年咨询委员会来吸引利益相关者，开展形成性活动 研究、调整行为干预模块并开发数据收集工具。 UG3-2. 招募 AGYW 建立抽样框架并进行离散选择实验 系统地评估对 HIV 诊所服务的偏好（1,000 名 10 至 20 岁的 HIV-/u AGYW 和 800 名 16 至 24 岁的 HIV+ AGYW），以确保 IWC 诊所能够满足 AGYW 的需求。 UG3-3. 制定 IWC 诊所服务交付和结构的标准操作程序 (SOP)，确定 培训 IWC 诊所工作人员，与青年顾问委员会合作，创造一个对青年友好的环境，以及 进行试点研究以评估实施流程（25 AGYW）。 UH3-1. 评估个人多层次干预措施 6 个月和 12 个月的效果（HIV 知识、 自我效能）、人际关系（社会支持、减少耻辱）和卫生系统（IWC 诊所）关于艾滋病毒的水平 使用整群随机设计进行测试、保留护理和病毒载量抑制。 UH3-2. 在 12 个月时与临床工作人员和同行导航员进行深入访谈以获取反馈 综合护理服务模式，以评估可持续性、记录最佳实践并更新标准操作程序 支持扩大 AGYW 综合服务。 UH3-3. 进行成本效益和预算分析，以评估和描述艾滋病毒护理的影响 持续向国家合作伙伴和国际社会传播调查结果。 这种综合服务交付模式如果成功，还可以作为实施额外服务的平台。 预防服务，包括针对高风险 AGYW 的暴露前预防 (PrEP)，目前正在实施中 政府考虑。