Efficacy of a differentiated care intervention for adolescents transitioning to adult HIV care in Peru

秘鲁青少年向成人艾滋病毒护理过渡的差异化护理干预措施的效果

• 批准号: 10704639
• 负责人: Molly Forrest Franke
• 金额: $ 65.01万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704639
• 关键词: Acute; Address; Adherence; Adolescence; Adolescent; Adoption; Adult; Advocate; Age; Appointment; Behavioral; Brain; Caregivers; Caring; Childhood; Chronic; Clinic; Communities; Community Health; Compensation; Complex; Continuity of Patient Care; Coping Skills; Data; Development; Diagnosis; Disclosure; Disease Management; Disparity; Distress; Education; Effectiveness; Effectiveness of Interventions; Emotional; Ensure; Environment; Face; HIV; HIV-infected adolescents; Health; Health Personnel; Health Services; Health system; Healthcare; Homelessness; Incidence; Informal Social Control; Insurance; Intervention; Intervention Studies; Intervention Trial; Latin America; Latin American; Life; Medical; Mental Health; Morbidity - disease rate; Neurocognitive; Outcome; Pathway interactions; Patient Care; Patients; Personal Satisfaction; Peru; Pilot Projects; Prefrontal Cortex; Pregnancy; Provider; Psychosocial Assessment and Care; Puberty; Public Sector; Qualitative Methods; Readiness; Rewards; Risk; Risk Taking; Self Efficacy; Social isolation; Social support; Substance Use Disorder; Support Groups; Testing; Time; Training; Trauma; Treatment Efficacy; Viral Load result; age group; arm; barrier to care; cohort; cost; cost effectiveness; cost estimate; early experience; early life adversity; economic evaluation; experience; housing instability; implementation evaluation; implementation intervention; improved; medication compliance; multidisciplinary; peer; peer influence; peer networks; perceived stress; post intervention; programs; psychosocial; randomized trial; randomized, clinical trials; screening; secondary endpoint; sexual debut; skills; social stigma; therapy design; transmission process; uptake

PROJECT SUMMARY The transition from pediatric to adult care is an exceptionally precarious time in adolescent HIV care. Yet, little is known about which interventions might be most effective in supporting adolescents through this period. We will build on our well-established community-health platform and existing intervention research with adolescents living in Lima, Peru, to provide critical data on the effectiveness, cost, and implementation of a promising community-based differentiated care intervention that supports adolescents as they transition to adult HIV care. Our recent pilot study among a diverse group of 30 adolescents in Peru, the first of its kind in Latin America, demonstrated broadscale acceptability and convincing evidence of effectiveness with regard to outcomes of adherence, social support, self-efficacy and transition readiness. The intervention consists of stabilization of acute needs (e.g., housing instability or homelessness); health systems navigation to overcome administrative barriers to care (i.e., insurance changes, health center transfers); accompaniment to appointments in the adult clinic; social support groups; education and skills-building sessions; and mental health screening and referrals. The intensity of support and duration of the intervention (6 months or 12 months) will be differentiated based on patient-level factors such as adherence, viral load suppression, presence of familial support, and transition readiness. We will conduct a two-arm randomized clinical trial to determine the short- and long-term (i.e., post-intervention) efficacy of the intervention with regard to retention with viral load suppression as well as other indicators of well- being. We will compare the cumulative incidence of unsuccessful transition at 12- and 24-months, and stratify findings by the differentiated care pathway (i.e., the intensity of the intervention received). We will estimate the cost and cost-effectiveness of the study intervention in terms of cost per additional successful transition achieved. And, we will provide data on implementation considerations essential for uptake, sustainability, and successful adoption by the public sector. These include the reach of the intervention and the effectiveness and relative importance of each intervention component over the short and long-term. In pursuing these aims we will address a critical disparity of information with regard to interventions for adolescents living with HIV in the Latin American context.

项目摘要 在青少年艾滋病毒护理中，从小儿到成人护理的过渡是一个异常不稳定的时期。但是，很少 知道在此期间，哪些干预措施可能最有效地支持青少年。我们 将建立在我们公认的社区健康平台和与青少年的现有干预研究的基础上 居住在秘鲁的利马，提供有关有希望的有效性，成本和实施的关键数据 基于社区的差异化护理干预措施在过渡到成人艾滋病毒护理时支持青少年。 我们最近在秘鲁的30名青少年组成的不同小组中的试点研究，这是拉丁美洲的第一个， 证明了广泛的可接受性和令人信服的有效性证据 坚持，社会支持，自我效能和过渡准备。干预包括稳定 急性需求（例如住房不稳定或无家可归）；卫生系统导航以克服管理 护理障碍（即保险变更，健康中心转移）；成人任命的伴奏 诊所;社会支持小组；教育和技能建设课程；以及心理健康筛查和推荐。 支持和干预持续时间的强度（6个月或12个月）将根据 患者级别的因素，例如依从性，病毒负荷抑制，存在家族支持和过渡 准备。 我们将进行两臂随机临床试验，以确定短期和长期（即干预后） 干预对保留病毒负荷抑制以及其他良好指标的疗效 存在。我们将比较12个月和24个月的失败过渡的累积发生率，并分层 通过分化护理途径的发现（即接受干预的强度）。我们将估计 研究干预的成本和成本效益，每次成功过渡的成本 成就了。而且，我们将提供有关实施注意事项的数据，可用于吸收，可持续性和 公共部门成功采用。这些包括干预的范围以及有效性和 每个干预组件在短期和长期内的相对重要性。在追求这些目标时，我们将 解决有关拉丁语中艾滋病毒的青少年的干预措施的关键信息差异 美国背景。