ZAIMARA: Zambian Informed Motivated Aware and Responsible Adolescents and Adults

扎马拉：赞比亚知情、积极、有意识、负责任的青少年和成年人

• 批准号: 10749138
• 负责人: Carolyn Bolton
• 金额: $ 96.85万
• 依托单位: CENTRE FOR INFECTIOUS DISEASE RESEARCH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-12 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749138
• 关键词: 18 year old; 19 year old; 2 arm randomized control trial; AIDS prevention; Address; Adherence; Adolescent; Adult; Area; Attention; Automobile Driving; Awareness; Chicago; Clinical; Clinical Research; Communities; Control Groups; Coupled; Distress; Ensure; Evidence based program; Exploration, Preparation, Implementation, and Sustainment; Failure; Feedback; Feeling; Female Adolescents; Focus Groups; Funding; Geography; Goals; Government; HIV; HIV Infections; HIV-infected adolescents; Health; Health Personnel; Health Promotion; Health Services; Hour; Human immunodeficiency virus test; Hybrids; Illinois; Incidence; Individual; Infection; Infectious Diseases Research; Intervention; Interview; Job Satisfaction; Logic; Medical; Mental Health; Methods; Minor; Modeling; Mothers; Occupations; Outcome; Participant; Patient Self-Report; Positioning Attribute; Prevalence; Primary Prevention; Program Sustainability; Province; Psyche structure; Public Health; Randomized; Research; Research Infrastructure; Resource-limited setting; Resources; Risk; Safe Sex; Sex Behavior; Sexually Transmitted Diseases; South Africa; Specific qualifier value; United States; United States National Institutes of Health; Universities; Viral; Workplace; Zambia; black women; burnout; catalyst; condoms; cost; design; dissemination science; effective intervention; effectiveness evaluation; effectiveness outcome; effectiveness/implementation trial; evidence base; follow-up; high risk; implementation outcomes; implementation research; implementation science; implementation strategy; informant; male; peer; performance site; pilot test; poor health outcome; pre-exposure prophylaxis; prevention service; programs; psychosocial; screening; sex; sexual risk taking; sexually active; social; stem; success; testing uptake; transmission process; treatment arm; uptake; working group; young woman

Project Abstract Zambia is struggling to meet the 95-95-95 targets for adolescent girls and young women (AGYW). HIV prevalence in 15-19 year-olds is 3.3%, and AGYW are 4 times more likely to acquire HIV than their male peers (8.6% vs. 2.1%). HIV incidence increased in AGYW from 2010-2020 while decreasing in all other groups, yet HIV testing rates are low (45.4%), and 71.2% do not know their HIV status. The proposed hybrid trial will evaluate the effectiveness and implementation of a CDC “best-evidence” intervention, Informed Motivated Aware and Responsible Adolescents and Adults (IMARA), recently adapted for South Africa (IMARA-SA) with promising effects on AGYW STI incidence, sexual risk taking, PrEP uptake, and mental health. Guided by the Exploration, Preparation, Implementation, Sustainment framework and an Implementation Research Logic Model, this study addresses a key driver of poor sustainability of evidence-based programs in low-resource settings - attrition in health workforce due to mental distress and low job satisfaction – by evaluating the impact of mental health screening and referral on peer leaders delivering IMARA. Building on preliminary focus groups with key stakeholders in Zambia, the study aims to: (1) Tailor IMARA-SA for the Zambian context to produce ZAIMARA; (2) Compare the effects of ZAIMARA vs. a general health promotion program on AGYW HIV testing uptake at 6 months (primary clinical outcome), incident STIs (including HIV), sexual behavior, and PrEP uptake (secondary clinical outcomes) at baseline, 6-, 12-, 18-, and 24 months. (3) Examine the impact of mental health screening and referral vs. a general check-in on peer leader job retention. (4) Evaluate ZAIMARA implementation outcomes using mixed methods and key informant interviews. The partnership between the Centre for Infectious Disease Research in Zambia (CIDRZ) and the Center for Dissemination and Implementation Science (CDIS) in the United States will ensure the expertise needed to complete the study in five geographically distinct communities in Lusaka Province, the region with the highest HIV prevalence in Zambia, while building capacity for implementation science research. This is a theoretically-grounded, hypothesis-driven hybrid-trial that addresses critical gaps in the HIV prevention continuum for Zambian AGYW, with a long-term goal to sustain effective programs that reduce HIV/STI infections.

项目摘要 赞比亚正在努力达到青少年女孩和年轻女性（AGYW）的95-95-95目标。艾滋病病毒 15-19岁的患病率为3.3％，AGYW获得HIV的可能性是男性同龄人的4倍 （8.6％比2.1％）。从2010 - 2020年开始，AGYW的HIV发病率增加，同时在所有其他群体中减少，但HIV 测试率较低（45.4％），而71.2％的测试率不知道其HIV状况。拟议的混合动力试验将评估 疾病预防控制中心“最佳证据”干预的有效性和实施，有动力的意识和 负责任的青少年和成人（IMARA），最近适应了南非（IMARA-SA）的承诺 对AGYW STI事件的影响，性风险服用，预备力吸收和心理健康。在探索的指导下， 准备，实施，维持框架和实施研究逻辑模型，本研究 解决了低资源环境中基于证据计划可持续性差的关键驱动力 - 由于精神困扰和工作满意度而导致的健康劳动力 - 通过评估心理健康的影响 筛选和转介给同伴领导者交付Imara。以钥匙为基础的初步焦点小组 赞比亚的利益相关者的目的是：（1）为赞比亚的背景量身定制imara-sa来生产Zaimara； （2） 比较Zaimara与一般健康促进计划对AGYW HIV测试吸收的影响 月份（主要临床结果），事件性传播感染（包括艾滋病毒），性行为和预期摄取（次要 临床结果）在基线，6，12-，18和24个月时。 （3）检查心理健康筛查的影响和 推荐与同伴领导者职位保留的一般签到。 （4）使用 混合方法和主要线人访谈。传染病研究中心之间的伙伴关系 在赞比亚（CIDRZ）和美国传播与实施科学中心（CDI）将在美国 确保在卢萨卡省的五个地理上不同社区完成这项研究所需的专业知识， 赞比亚艾滋病毒患病率最高的地区，同时建立了实施科学研究的能力。 这是一种理论上的，假设驱动的混合审判，可解决预防HIV的关键差距 赞比亚AGYW的连续性，其长期目标是维持减少艾滋病毒/性传播感染感染的有效计划。