Bridges2Scale: Testing implementation strategies for an intervention among young people affected by AIDS

Bridges2Scale：测试对受艾滋病影响的年轻人进行干预的实施策略

• 批准号: 10713990
• 负责人: Noeline Nakasujja
• 金额: $ 67.54万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10713990
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Affect; Africa South of the Sahara; Age; Behavior; Businesses; Caring; Clinical effectiveness; Communities; Contracts; Development; Economics; Education; Educational Status; Effectiveness; Ensure; Evidence based practice; Family; Foundations; Funding; Future; Government; HIV; HIV Seronegativity; Health; Household; Hybrids; Incentives; Income; Intervention; Interview; Investments; Kenya; Maps; Mental Health; Mentorship; Methods; Modification; Outcome; Outcome Measure; Participant; Penetration; Perception; Persons; Preparation; Prevalence; Process; Protocols documentation; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research; Research Priority; Resource-limited setting; Risk; Risk Taking; Savings; Schools; Signal Transduction; Site; Structure; Students; System; Testing; Training; Uganda; Underserved Population; United States National Institutes of Health; Viral; Youth; arm; cohesion; comparative cost effectiveness; cost; cost comparison; cost effectiveness; design; economic evaluation; effectiveness evaluation; empowerment; experience; financial literacy; implementation determinants; implementation outcomes; implementation process; implementation strategy; implementation/effectiveness; improved; meetings; member; post intervention; pre-exposure prophylaxis; primary outcome; psychosocial; public-private partnership; randomized, clinical trials; recruit; scale up; sexual risk taking; standardize measure; theories; transmission process; treatment adherence

PROJECT ABSTRACT Sub-Saharan Africa (SSA), a region dominated by low-resource communities and relatively poor families, is experiencing rising HIV prevalence among adolescents and youth (AY). Household economic hardships heighten the risk for AY’s engaging in health-compromising behaviors and their poor engagement with care. This increases their risk for contracting and transmitting HIV and non-adherence to ART treatment. Economic empowerment (EE) interventions have demonstrated substantial promise in reducing HIV-related risk-taking behaviors, and improving ART treatment adherence and mental health outcomes. Based on 10+ years of research utilizing savings-led EE interventions focused on HIV prevention, care and support for AY affected by HIV [AYaAIDS] (including AY living with HIV [AYLHIV]; and AY orphaned by AIDS [AYoAIDS] in SSA, our group has demonstrated the effectiveness of a multi-component EE intervention, Bridges, in four NIH-funded randomized control trials (RCT) in Uganda (R01 HD070727, R01HD074949, R34MH081763, R01MH113486), and one foundation-funded study in Kenya. Bridges involves: 1) financial literacy training (FLT) and mentorship; 2) family income-generating activities (IGA); and 3) incentivized savings via a matched Youth Development Account (YDA). Bridges has demonstrated robust effects on HIV-related risk-taking behaviors, ART adherence, mental health, psychosocial outcomes, educational achievement, family economics, and family cohesion. Yet, scaling EE interventions has been a challenge, signaling the need to identify and test scale-up strategies and examine determinants of implementation and sustainment. In Bridges2Scale, we will compare two multifaceted strategies (standard vs enhanced) for scaling Bridges in a two-arm Hybrid III effectiveness-implementation cluster RCT. The standard implementation strategy has been applied in our prior RCTs and involves educational meetings that prepare staff to deliver Bridges with minimal disruption to site workflow. This will be compared to an enhanced strategy that will be developed using Implementation Mapping. We will use the public school system to recruit 1440 AYaAIDS (ages 13-17 years) from 48 schools in the Greater Masaka region of Uganda, a region with 11.7% HIV prevalence. Schools will be the unit of randomization (n=24 schools per arm; n=720 students per arm). Four specific aims guide our study: Aim 1. Compare the implementation effectiveness of the standard implementation strategy vs. an enhanced implementation strategy; Aim 2. Determine the clinical effectiveness of Bridges implemented via a standard vs. enhanced implementation strategy; Aim 3. Explore implementation processes, mechanisms, and determinants; and Aim 4. Compare the cost and cost-effectiveness of the two implementation strategies. The study will address a critical challenge: how to best support the implementation, scale-up, and sustainment of EE interventions, which have been proven to be highly efficacious in improving youth-focused HIV prevention, care, and support outcomes, but are yet to be widely scaled up.

项目摘要 撒哈拉以南非洲（SSA）是一个由低资源社区和相对贫困家庭主导的地区 青少年和青年（AY）的HIV患病率不断上升。家庭经济困难增加 AY参与卫生促进行为的风险及其在照顾方面的差异不佳。这 增加了他们收缩和传播艾滋病毒的风险以及不遵守艺术治疗的风险。经济的 授权（EE）干预措施在减少与HIV相关的冒险方面表现出了重大的希望 行为，改善艺术治疗依从性和心理健康结果。基于10年以上的 利用储蓄领导的EE干预措施的研究重点是预防艾滋病毒，对AY的护理和支持 艾滋病毒[ayaaids]（包括艾滋病毒[aylhiv]的生活；以及由ssa的艾滋病（Ayoaids）的孤儿，我们的小组 已经证明了多组分的桥梁在四个NIH资助中的桥梁的有效性 乌干达的随机对照试验（RCT） （R01 HD070727，R01HD074949，R34MH081763，R01MH113486），） 以及一项在肯尼亚的基金会资助的研究。桥梁涉及：1）金融素养培训（FLT）和Mentalship； 2）家庭收入的活动（IGA）； 3）通过匹配的青年发展激励节省 帐户（YDA）。桥梁表现出对与HIV相关的冒险行为，艺术依从性的强大影响， 心理健康，社会心理成果，教育成就，家庭经济学和家庭凝聚力。然而， 扩展EE干预一直是一个挑战，表明需要识别和测试扩展策略和 检查确定实施和维持。在Bridges2scale中，我们将比较两个多方面 在两臂混合III效率实施中，用于扩展桥的策略（标准与增强） 群集RCT。标准实施策略已在我们的先前RCT中应用，涉及教育 会议使员工为交付桥梁的桥梁而造成最小的破坏场地工作流程。这将被比较 将使用实施映射制定的增强策略。我们将使用公立学校系统 从乌干达大马萨卡地区的48所学校招募1440 Ayaaid（13-17岁） HIV患病率为11.7％。学校将成为随机化的单位（n =每只手臂24所学校； n = 720名学生 每只手臂）。四个具体目标指导我们的研究：目标1。比较标准的实施效率 实施策略与增强的实施策略；目标2。确定临床有效性 通过标准与增强实施策略实施的桥梁；目标3。探索实施 过程，机制和确定；和目标4。比较两者的成本和成本效益 实施策略。该研究将解决一个关键挑战：如何最好地支持实施， EE干预措施的扩展和维持，事实证明，这些干预措施在改善方面非常有效 以青少年为中心的艾滋病毒预防，关心和支持结果，但尚未得到广泛缩小。