Developing and Testing a Multi-level Package of Interventions for an Integrated Care Delivery Model of HIV Prevention and Treatment in Zambia: Targeting Adolescent Boys and Young Men

制定和测试赞比亚艾滋病毒预防和治疗综合护理服务模式的多层次干预措施：以青春期男孩和年轻男性为目标

• 批准号: 10355670
• 负责人: SUJHA SUBRAMANIAN
• 金额: $ 3.21万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10355670
• 关键词: AIDS prevention; Administrative Supplement; Adolescence; Adolescent; Adolescent and Young Adult; Affect; Africa South of the Sahara; Age; Caring; Clinic; Cluster randomized trial; Complement; Continuity of Patient Care; Data; Data Collection; Diagnosis; Dimensions; Economics; Education; Effectiveness of Interventions; Enrollment; Ensure; Face; Female Adolescents; Future; Gender Role; Goals; HIV; Health system; High Prevalence; Human immunodeficiency virus test; Incidence; Individual; Intervention; Knowledge; Learning Module; Male Adolescents; Mental Health; Outcome; Parents; Pharmaceutical Preparations; Prevalence; Prevention Research; Randomized; Risk; Self Efficacy; Service delivery model; Services; Social support; System; Testing; Time; Training; Treatment outcome; Variant; Viral Load result; Zambia; age group; aged; base; boys; cohort; community intervention; community setting; cost; cost effectiveness; design; efficacy outcomes; emerging adult; experience; gender difference; gender equality; girls; health care delivery; implementation cost; implementation measures; implementation outcomes; improved; improved outcome; male; multi-component intervention; parent grant; peer; policy implication; preventive intervention; programs; scale up; social; social stigma; standard of care; substance use; trend; young adult; young man; young woman

PROJECT SUMMARY/ABSTRACT Zambia has one of the highest incidences of HIV in the world. Adolescent girls and young women (AGYW) are a particularly affected group because of their social and economic vulnerability. There is growing recognition of the importance of including adolescent boys and young men (ABYM) in HIV prevention research. During adolescence and early adulthood, boys have significantly lower HIV prevalence than AGYW. However, adolescent boys experience large increases in HIV prevalence in the years that follow, which thereby indicates that adolescence may be a critical time when boys should be engaged in HIV prevention. With this administrative supplement, we propose to add a cohort of ABYM to explore the efficacy of tailored multilevel interventions on HIV outcomes. The overall goal of the supplement is to assess gender differences related to both efficacy and implementation outcomes of the multicomponent interventions. We will develop tailored education materials targeted at ABYM to complement the SHIELD (Support for HIV Integrated Education, Linkages to care, and Destigmatization) education modules developed for AGYW. We will conduct similar interventions for ABYM as planned for AGYW in the community setting and support linkages to the Integrated Wellness Care (IWC) clinics already established for the parent study. We will select 300 ABYM from the previously enrolled cohort for inclusion in the study. As stated in the parent grant, we will compare (1) the SHIELD community intervention only, (2) SHIELD and clinic-based interventions, and (3) the standard of care. We will pursue the following specific aims in this administrative supplement: Aim 1 is to include ABYM in assessing efficacy at 6 and 12 months of the multilevel interventions at the individual (HIV knowledge, self-efficacy), interpersonal (social support, stigma reduction), and health system (clinic-based multiple services) levels on HIV testing, retention in care, and viral load suppression using a cluster randomized design and Aim 2 is to assess implementation outcomes and cost-effectiveness of the interventions targeted at ABYM to support scale-up and sustainability. Including a cohort of ABYM will enhance the study by supplementing the data gathered from the cohort of AGYW to understand the impact of gender equality and norms on outcomes along the HIV continuum of care. The findings from the supplement and parent grant will allow us to design a comprehensive program for adolescents that can be implemented in the community setting along with sustainable linkages to the existing health care delivery system.

项目概要/摘要 赞比亚是世界上艾滋病毒发病率最高的国家之一。青春期女孩和年轻女性 (AGYW) 由于其社会和经济脆弱性，他们是特别受影响的群体。有不断增长的 认识到将青春期男孩和年轻男性 (ABYM) 纳入艾滋病毒预防的重要性 研究。在青春期和成年早期，男孩的艾滋病毒感染率明显低于男孩 AGYW。然而，在接下来的几年里，青春期男孩的艾滋病毒感染率大幅上升， 这表明青春期可能是男孩感染艾滋病毒的关键时期 预防。 通过这个行政补充，我们建议添加一组 ABYM 来探索定制的功效 对艾滋病毒结果的多层次干预。该补充剂的总体目标是评估性别差异 与多成分干预措施的功效和实施结果相关。我们将开发 针对 ABYM 量身定制的教育材料，以补充 SHIELD（支持艾滋病毒综合 为 AGYW 开发的教育模块。我们将 在社区环境和支持联系方面对 ABYM 进行与 AGYW 计划类似的干预措施 到已为家长研究建立的综合健康护理 (IWC) 诊所。我们将选出300名 来自先前纳入研究的队列的 ABYM。正如家长补助金中所述，我们将 比较 (1) 仅 SHIELD 社区干预，(2) SHIELD 和基于临床的干预措施，以及 (3) 护理标准。我们将在本行政补充文件中追求以下具体目标： 目标 1 是 将 ABYM 纳入个人多层次干预措施 6 个月和 12 个月的疗效评估（HIV 知识、自我效能）、人际交往（社会支持、减少耻辱）和卫生系统（以诊所为基础） 使用集群进行艾滋病毒检测、保留护理和病毒载量抑制的多种服务）水平 随机设计，目标 2 是评估实施结果和成本效益 针对 ABYM 的干预措施，以支持扩大规模和可持续性。 纳入 ABYM 队列将通过补充从 ABYM 队列收集的数据来加强研究 AGYW 了解性别平等和规范对艾滋病毒连续性结果的影响 关心。补助金和家长补助金的调查结果将使我们能够设计一个全面的计划 对于青少年来说，可以在社区环境中实施，并与社会保持可持续的联系 现有的医疗保健提供系统。