Improving Retention in Care for Adolescents and Young Adults in Kenya: Implementation Science to Support Adaptation and Integration of a Stepped Care Intervention

提高肯尼亚青少年和年轻人的护理保留率：实施科学以支持阶梯式护理干预措施的适应和整合

• 批准号: 10402611
• 负责人: Nok Chhun
• 金额: $ 4.61万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-16 至 2025-06-15
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402611
• 关键词: Address; Adolescent; Adolescent and Young Adult; Adoption; Adult; Africa South of the Sahara; Area; Caring; Characteristics; Client; Clinical; Consolidated Framework for Implementation Research; Data; Development; Effectiveness of Interventions; Eligibility Determination; Ensure; Evaluation; Evidence based intervention; Failure; Feedback; Focus Groups; Frequencies; Future; Goals; HIV; HIV Infections; HIV-infected adolescents; Health Personnel; Health Services; Health care facility; Health system; Healthcare Systems; Individual; Intervention; Interview; Kenya; Measures; Methodology; Methods; Modeling; Modification; Nature; Outcome; Parents; Penetration; Perception; Persons; Phase; Procedures; Process; Qualitative Methods; Randomized Controlled Trials; Readiness; Recommendation; Reporting; Research; Research Personnel; Resource-limited setting; Resources; Risk; Service delivery model; Services; Surveys; Testing; Time; Time Series Analysis; Training; Treatment outcome; Variant; Viral; Youth; community based care; doctoral student; effectiveness evaluation; evidence base; follow-up; health care settings; high-risk adolescents; implementation determinants; implementation evaluation; implementation facilitators; implementation intervention; implementation outcomes; implementation science; implementation strategy; improved; meetings; model design; mortality; post intervention; pre-doctoral; preference; risk prediction; routine practice; scale up; service delivery; skills; social; success; tool; treatment adherence; trend

Abstract Worldwide, five million adolescents and young adults (AYA) are living with HIV. More than 90% of global HIV- related mortality among AYA occurs in sub-Saharan Africa. A limited but growing evidence base of interventions available for adolescents in sub-Saharan Africa highlight the importance of retention in care for improving treatment outcomes. To meet AYA where they are in their engagement with the healthcare system, interventions need to be feasible, acceptable, and appropriate for local healthcare settings and practice. This F31 project leverages a cluster randomized controlled trial, Data-informed Stepped Care to Improve Adolescent HIV Outcomes (UG3/UH3 HD096906; PIs: Kohler, John-Stewart) that is testing a Stepped Care intervention to improve retention among adolescents and young adults living with HIV in western Kenya. This F31 project aims to evaluate early phase implementation outcomes of the Stepped Care intervention as it is delivered across 10 healthcare facilities. Aim 1 will identify adaptations made to the intervention (materials, procedures, or delivery) that influence acceptability, feasibility, and appropriateness. The Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) will be used to characterize adaptations and modifications necessary for facility-specific optimization of the intervention. Aim 2 will identify the barriers and facilitators that impact penetration, coverage, and fidelity of the Stepped Care intervention. We will apply the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators of implementation to understand the context and intervention characteristics influencing implementation of the Stepped Care intervention. Finally, Aim 3 will match barriers to successful implementation to targeted strategies to overcome them, producing a package of intervention implementation options that promote long-term intervention adoption and sustainability. Findings from this project will contribute to understanding optimization of Stepped Care and provide valuable information about the context necessary for successful scale-up of Stepped Care interventions for adolescents and young adults within Kenya or scale out to other global settings. The research plan will provide the F31 candidate, an implementation science pre-doctoral student, with rigorous training in (1) implementation science conceptual frameworks, models, design and methodology; (2) training in qualitative methods; and (3) content-area expertise regarding evidence-based interventions for adolescents and young adults living with HIV.

抽象的 在全球范围内，有500万青少年和年轻人（AYA）生活在艾滋病毒中。超过90％的全球艾滋病毒 AYA之间的相关死亡率发生在撒哈拉以南非洲。干预措施有限但不断增长的证据基础 可用于撒哈拉以南非洲的青少年 治疗结果。要与他们参与医疗保健系统的AYA结识AYA，请采取干预措施 需要可行，可接受且适合当地医疗保健环境和实践。这个F31项目 利用群集随机对照试验，数据知识的阶梯护理以改善青少年艾滋病毒 结果（UG3/UH3 HD096906; PIS：Kohler，John-Stewart）正在测试阶梯护理干预措施 改善肯尼亚西部艾滋病毒的青少年和年轻人的保留率。这个F31项目的目标 评估阶梯护理干预措施的早期实施结果，因为它是在10个 医疗机构。 AIM 1将确定对干预措施的改编（材料，程序或交付） 这会影响可接受性，可行性和适当性。报告改编的框架和 修改基于证据的干预措施（框架）将用于表征适应和 对干预措施的特定设施优化所需的修改。 AIM 2将确定障碍和 影响阶梯护理干预措施的渗透率，覆盖范围和忠诚度的促进者。我们将应用 合并实施研究框架（CFIR）检查障碍和促进者 实施以了解影响实施的上下文和干预特征 阶梯式护理干预措施。最后，AIM 3将使成功实施的障碍与有针对性的策略相匹配 为了克服它们，生产一套干预实施方案，以促进长期 干预采用和可持续性。该项目的发现将有助于理解优化 阶梯式护理，并提供有关成功扩大规模所必需的上下文的宝贵信息 对肯尼亚的青少年和年轻人进行了护理干预措施，或扩展到其他全球环境。 该研究计划将为F31候选人提供严格的实施科学候选人，该候选人 （1）实施科学概念框架，模型，设计和方法论的培训； （2）培训 定性方法； （3）关于青少年和 患有艾滋病毒的年轻人。