Implementation Research to Optimize ART Delivery for Adolescent Girls and Young Women Living with HIV in Tanzania

优化坦桑尼亚艾滋病毒感染青春期女孩和年轻女性抗逆转录病毒治疗的实施研究

• 批准号: 10547999
• 负责人: Katherine B Rucinski
• 金额: $ 15.97万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10547999
• 关键词: Active Learning; Address; Adolescence; Adolescent; Adolescent Development; Adolescent Health Services; Adolescent and Young Adult; Adopted; Africa South of the Sahara; Age; Award; Caring; Characteristics; Clinic; Communities; Consolidated Framework for Implementation Research; Data; Development; Diagnosis; Eastern Africa; Economics; Educational workshop; Effectiveness; Effectiveness of Interventions; Emotional; Ensure; Evidence based intervention; Female Adolescents; Focus Groups; Foundations; Funding; Goals; Government; HIV; HIV Infections; Health; Health care facility; Hour; Hybrids; Incidence; Infection; Institutional Practice; Interdisciplinary Study; Intervention; Interview; Investments; Link; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; Partnership Practice; Patients; Pattern; Personal Satisfaction; Physiological; Population; Positioning Attribute; Poverty; Prevention; Prevention program; Process; Provider; Psychiatric Social Work; Qualitative Research; Randomized; Recommendation; Reproductive Health Services; Research; Research Methodology; Research Personnel; Research Project Grants; Resource-limited setting; Risk; Services; Sexual Health; Social Behavior; Southern Africa; Structure; Surveys; System; Tanzania; Teenagers; Testing; Time; Training; Training Programs; Viral; Woman; adolescent health; aged; antiretroviral therapy; career; effectiveness trial; emerging adult; girls; health care delivery; high risk; implementation research; implementation science; implementation strategy; improved; innovation; lens; meetings; mortality; multidisciplinary; peer; peer support; programs; response; scale up; skills; social exclusion; social stigma; social structure; theories; therapy adherence; tool; transmission process; uptake; young woman

PROJECT SUMMARY This five-year K01 Mentored Research Scientist Development Award will provide Dr. Rucinski with the mentorship and training to become an independent investigator focused on research that optimizes the health and well-being of women and girls at high risk of HIV acquisition and transmission in sub-Saharan Africa. Training is at the foundation of this proposal and comprises mentorship with expert and multi-disciplinary implementation science (IS) researchers, didactic coursework, experiential learning, meetings with key HIV and stakeholders and community leaders, and rigorous mentored research. The following training objectives will be accomplished during this award: (1) Obtain scientific expertise in the concepts, theories, tools and methods used to advance HIV-related IS research and practice; (2) Develop comprehensive skills in qualitative research methods to support the application of mixed-methods approaches for HIV-related IS research; and (3) Acquire content expertise in adolescent health and development to inform the tailoring, adaptation, and testing of developmentally appropriate sexual and reproductive health services for adolescents and young adults. Supported by these objectives, the proposed mentored research project will generate a tailored packaged of implementation strategies to strengthen contextually appropriate antiretroviral therapy (ART) programs for adolescent girls and young women (AGYW) aged 15-24 living with HIV in Dar es Salaam. In Tanzania, a quarter of all new annual HIV infections are among AGYW. Despite efforts to decrease incident infections, the number of AGYW living with HIV in southern and eastern Africa continues to rise and increasingly, the burden is among those with sexually acquired HIV . Further, more than half of the 130,000 AGYW living with HIV in Tanzania are virally unsuppressed, increasing their risk for onward HIV transmission, morbidity, and mortality. Few evidence- based interventions exist to improve retention in care and viral suppression for adolescents, and even fewer have been implemented at scale. Peer support models known as “teen clubs” have been prioritized by PEPFAR and the Government of Tanzania for scale up. Yet evidence to support the feasibility, acceptability, and effectiveness of this intervention is mixed, and implementation research is needed to close the evidence to practice gap. Guided by a community-driven implementation planning framework and the Consolidated Framework for Implementation Research (CFIR), we propose the following aims in Dar es Salaam: (1) Examine the social, structural, and clinic-level factors associated with retention in care and HIV viral suppression among AGYW participating in the DREAMS prevention program who were newly infected or diagnosed with HIV; (2) Refine a tailored package of implementation strategies to optimize a peer-support model for HIV treatment; and (3) Pilot the feasibility, acceptability, and preliminary effectiveness of a tailored package of implementation strategies for AGYW living with HIV. Findings will form the foundation for a R01-level randomized hybrid effectiveness trial and will facilitate Dr. Rucinski’s transition to independence.

项目概要 这项为期五年的 K01 指导研究科学家发展奖将为 Rucinski 博士提供 指导和培训，成为一名专注于优化健康研究的独立研究者 撒哈拉以南非洲地区感染和传播艾滋病毒高风险的妇女和女孩的福祉和福祉培训。 是该提案的基础，包括专家和多学科的指导 实施科学（IS）研究人员、教学课程、体验式学习、与关键人物的会议 艾滋病毒和 利益相关者和社区领导者，以及严格的指导研究将是以下培训目标。 在此奖项期间取得的成就：（1）获得所使用的概念、理论、工具和方法方面的科学专业知识 (2) 培养定性研究的综合技能 支持混合方法应用于 HIV 相关 IS 研究的方法；以及 (3) 获取 青少年健康和发展方面的内容专业知识，为青少年健康和发展的定制、适应和测试提供信息 为青少年和年轻人提供适合发育的性健康和生殖健康服务。 在这些目标的支持下，拟议的指导研究项目 将生成一个定制的包 加强针对具体情况的抗逆转录病毒治疗（ART）计划的实施策略 在坦桑尼亚的达累斯萨拉姆，15-24 岁的少女和年轻女性 (AGYW) 感染艾滋病毒，四分之一。 尽管努力减少感染事件，但每年新感染艾滋病毒的人数仍占 AGYW 的比例。 在南部非洲和东部非洲，感染艾滋病毒的 AGYW 人数继续上升，而且负担越来越重 那些通过性行为获得艾滋病毒的人 此外，坦桑尼亚 130,000 名艾滋病毒感染者中，一半以上是 病毒未受抑制，增加了艾滋病毒继续传播、发病率和死亡率的风险。 现有的干预措施旨在改善青少年的护理保留和病毒抑制，但更少 被称为“青少年俱乐部”的同伴支持模式已被 PEPFAR 优先考虑。 和坦桑尼亚政府扩大规模尚有证据支持可行性、可接受性和 这种干预措施的有效性好坏参半，需要进行实施研究来关闭证据 以社区驱动的实施规划框架和综合框架为指导。 实施研究框架（CFIR），我们在达累斯萨拉姆提出以下目标：（1） 检查与保留护理和 HIV 病毒相关的社会、结构和临床层面因素 参与 DREAMS 预防计划的 AGYW 新感染者或 (2) 完善一套量身定制的实施策略，以优化同伴支持模式 艾滋病毒治疗；以及 (3) 试点定制方案的可行性、可接受性和初步有效性 艾滋病毒感染者 AGYW 实施策略的调查结果将构成 R01 级别的基础。 随机混合有效性试验将有助于 Rucinski 博士向独立过渡。