Developing an Instrument to Assess Adolescent Risk for Disengagement from HIV Care

开发一种工具来评估青少年脱离艾滋病毒护理的风险

基本信息

批准号：
9975907
负责人：
Leslie Anne Enane
金额：
$ 15.67万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9975907
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Acute Adolescent Adult Affect Africa African Age Algorithms Area Attention Beck depression inventory Caregivers Caring Case Management Cause of Death Cessation of life Childhood Clinic Clinical Clinical Management Clinical assessments Complex Counseling Databases Development Device or Instrument Development Early Intervention Enrollment Ensure Epidemic Epidemiology Evaluation Failure Family member Funding Goals HIV Health Health Personnel Individual Infection Infrastructure International Intervention Intervention Studies Interview Link Literature Mental Health Mental Health Services Mentors Mentorship Methods Modeling Outcome Patients Physicians Plant Roots Poverty Professional Competence Psychologist Questionnaires Research Research Methodology Research Personnel Resistance Resources Review Literature Risk Role Scientist Screening Result Screening procedure Social support Structure Tablets Testing Treatment outcome United States National Institutes of Health Viral Virus Wool Work age group antiretroviral therapy career clinical care cohort design evidence base high risk high-risk adolescents implementation science improved instrument mortality novel pediatric human immunodeficiency virus prevent research clinical testing retention rate scale up social stigma success successful intervention therapy design tool transmission process treatment optimization treatment program virology vulnerable adolescent

项目摘要

PROJECT SUMMARY / ABSTRACT HIV is a leading cause of death among adolescents globally, due to management challenges which result in poorer outcomes in the care cascade as compared to adults, including poor rates of retention in care. Reasons for disengagement from care have not been well-explored among adolescents, and are expected to be complex and heterogeneous. Interventions to improve retention can be resource intensive and are challenging to implement broadly. There is an urgent need to identify adolescents at high risk for disengagement from HIV care, and to intervene early to retain these adolescents, in order to prevent deaths and optimize treatment outcomes. Dr. Leslie Enane aims to become a productive independent investigator in HIV implementation science, focused on improving pediatric and adolescent outcomes in the HIV care cascade, particularly in resource-limited settings. The objectives of this application are to develop those career skills by 1) using a mixed-methods approach to investigate factors underlying disengagement among adolescents with HIV in East Africa, and 2) developing an instrument to identify adolescents at high risk for disengagement, for whom proactive interventions may support retention. This project will utilize the well-developed epidemiologic and implementation science infrastructure of the NIH-funded International Epidemiologic Database to Evaluate AIDS East Africa Consortium (IeDEA-EA). Dr. Enane will be mentored by Dr. Rachel Vreeman, Dr. Kara Wools-Kaloustian, Dr. J. Dennis Fortenberry, Dr. Edith Apondi, and Prof. Winstone Nyandiko. Dr. Enane will first refine a conceptual model for adolescent disengagement from HIV care. She will achieve this through systematic literature review; qualitative inquiry with disengaged adolescents, caregivers, and healthcare workers; and synthesis of these findings with quantitative work in IeDEA-EA defining predictors of adolescent outcomes in the care cascade. Next, she will work from this conceptual model to develop and pilot a reliable, developmentally- and culturally-relevant instrument to assess adolescent risk for disengagement from HIV care, the Clinical Assessment for Retention and Engagement (CARE). CARE will be designed for utility in busy clinical settings, to identify adolescents at high risk for disengagement, for whom early interventions should be considered. Dr. Enane will develop an evidence-based algorithm to support clinical evaluation and intervention for adolescents at risk for disengagement. The algorithm will link positive screening results in domains of CARE to administration of valid clinical questionnaires, and/or appropriate interventions, to optimally support clinical management of adolescents at risk for disengagement. Completing this work with strong mentorship and access to experts in implementation science in IeDEA-EA, Dr. Enane will develop independence as a physician-scientist in pediatric HIV implementation science, gaining expertise in 1) qualitative and mixed-methods research, 2) instrument development, and 3) the design of interventions to improve HIV outcomes. Findings will support her R01 proposal to study CARE as part of an intervention package to improve retention and HIV outcomes for adolescents.

项目概要/摘要艾滋病毒是全球青少年死亡的主要原因，由于管理方面的挑战导致与成人相比，护理级联的结果较差，包括护理保留率较低。原因青少年脱离照料的原因尚未得到充分探讨，预计会很复杂且异质。提高保留率的干预措施可能需要大量资源，并且对广泛实施。迫切需要确定脱离艾滋病毒护理的高风险青少年，并尽早干预以留住这些青少年，以防止死亡并优化治疗结果。 Leslie Enane 博士的目标是成为艾滋病毒实施科学领域富有成效的独立研究者，重点关注改善艾滋病毒护理级联中的儿科和青少年结局，特别是在资源有限的地区设置。此应用程序的目标是通过 1) 使用混合方法来培养这些职业技能调查东非艾滋病毒青少年脱离接触的因素的方法，以及 2) 开发一种工具来识别处于脱离接触高风险的青少年，并为他们采取积极干预措施可能支持保留。该项目将利用成熟的流行病学和实施科学美国国立卫生研究院资助的东非艾滋病评估联盟国际流行病学数据库的基础设施（即DEA-EA）。 Enane 博士将接受 Rachel Vreeman 博士、Kara Wools-Kaloustian 博士、J. Dennis 博士的指导 Fortenberry、Edith Apondi 博士和 Winstone Nyandiko 教授。 Enane 博士将首先完善一个概念模型青少年脱离艾滋病毒护理。她将通过系统的文献综述来实现这一目标；定性的询问无所事事的青少年、看护者和医护人员；并将这些发现综合 IeDEA-EA 中的定量工作定义了护理级联中青少年结果的预测因素。接下来，她将从这个概念模型出发，开发和试点一个可靠的、与发展和文化相关的评估青少年脱离艾滋病毒护理风险的工具，保留的临床评估和参与（CARE）。 CARE 的设计目的是为了在繁忙的临床环境中发挥作用，以识别青少年脱离接触的高风险，应考虑早期干预。 Enane 博士将开发一种基于证据的算法支持对有风险的青少年进行临床评估和干预脱离接触。该算法将把 CARE 领域的阳性筛查结果与有效的管理联系起来。临床问卷和/或适当的干预措施，以最佳地支持青少年的临床管理面临脱离接触的风险。在强有力的指导和实施专家的帮助下完成这项工作 Enane 博士将在 IeDEA-EA 的科学领域发展成为儿科艾滋病领域医师科学家的独立性实施科学，获得 1) 定性和混合方法研究、2) 仪器方面的专业知识开发，以及 3) 改善艾滋病结果的干预措施的设计。调查结果将支持她的 R01 提案研究 CARE 作为干预措施的一部分，以改善青少年的保留率和艾滋病毒结果。