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) 是一个以资源匮乏社区和相对贫困家庭为主的地区， 青少年 (AY) 中艾滋病毒感染率不断上升。 AY 从事危害健康的行为以及护理参与度不高的风险。 增加了他们感染和传播艾滋病毒以及不遵守抗逆转录病毒治疗的风险。 赋权 (EE) 干预措施在减少艾滋病毒相关风险方面已显示出巨大的希望 基于 10 多年的经验，改善 ART 治疗依从性和心理健康结果。 研究利用以储蓄为主导的 EE 干预措施，重点关注艾滋病毒预防、护理和支持受艾滋病影响的 AY HIV [AYaAIDS]（包括感染 HIV 的 AY [AYLHIV]；以及 SSA 中因艾滋病而成为孤儿的 AY [AYoAIDS]，我们的小组 已在 NIH 资助的四个项目中证明了多组件 EE 干预措施 Bridges 的有效性 乌干达的随机对照试验 (RCT) (R01 HD070727、R01HD074949、R34MH081763、R01MH113486)、 Bridges 的一项基金会资助的研究涉及：1) 金融知识培训 (FLT) 和指导； 2) 家庭创收活动 (IGA)；以及 3) 通过匹配的青年发展激励储蓄 账户 (YDA) 已证明对 HIV 相关的冒险行为、ART 依从性、 心理健康、心理社会结果、教育成就、家庭经济和家庭凝聚力。 扩大 EE 干预措施一直是一个挑战，这表明需要确定和测试扩大规模的策略和 在 Bridges2Scale 中，我们将比较两个方面的实施和维持的决定因素。 在两臂 Hybrid III 有效性实施中扩展 Bridges 的策略（标准与增强） 标准实施策略已应用于我们之前的随机对照试验并涉及教育。 会议旨在让工作人员做好准备，以尽量减少对现场工作流程的干扰来交付桥梁。 我们将使用公立学校系统来制定强化战略。 从乌干达大马萨卡地区的 48 所学校招募 1440 名 AYaAIDS（年龄 13-17 岁） HIV 感染率为 11.7% 的学校将成为随机分组的单位（每组 n=24 所学校；n=720 名学生） 我们的研究有四个具体目标： 目标 1. 比较标准实施的有效性 实施策略与强化实施策略 目标 2. 确定临床有效性 通过标准实施与实施增强策略实施的桥梁数量 目标 3. 探索实施； 流程、机制和决定因素；目标 4. 比较两者的成本和成本效益 该研究将解决一个关键挑战：如何最好地支持实施， 扩大和维持 EE 干预措施，已被证明在改善 以青年为重点的艾滋病毒预防、护理和支持成果，但尚未广泛推广。