Adapting and testing a combination peer navigation and mHealth intervention to enhance treatment engagement and viral suppression among sexual and gender minority youth in Nigeria

调整和测试同伴导航和移动医疗干预相结合，以提高尼日利亚性少数群体青年的治疗参与度和病毒抑制能力

• 批准号: 10619071
• 负责人: Lisa Mary Kuhns
• 金额: $ 68.55万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619071
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Adoption; Adult; Age; Anti-Retroviral Agents; Atlases; Caring; Cessation of life; Cities; Climate; Clinic; Clinics and Hospitals; Communities; Continuity of Patient Care; Country; Data; Development; Disclosure; Disparity; Environment; Epidemic; Evidence based intervention; Feedback; Friends; General Population; Geographic Locations; Goals; Guidelines; HIV; HIV Infections; HIV-1; Health; Infection; Intervention; Laws; Legal; Maintenance; Medical Records; Methods; Modeling; Morbidity - disease rate; Nigeria; Outcome; Persons; Pharmaceutical Preparations; Population; Prevalence; Prisons; Process; Randomized, Controlled Trials; Recommendation; Risk; Same-sex; Services; Sexual and Gender Minority Youth; Social support; Structure; Supportive care; Testing; Text Messaging; Universities; Viral; Viral Load result; Viremia; Youth; aged; antiretroviral therapy; burden of illness; care outcomes; community center; community setting; evidence base; implementation evaluation; implementation outcomes; improved; innovation; intervention participants; iterative design; mHealth; medication compliance; men; men who have sex with men; outreach; peer; preference; primary outcome; programs; psychosocial; routine care; same-sex marriage; same-sex partnership; satisfaction; secondary outcome; social; social stigma; therapy outcome; transgender women; viral transmission; young men who have sex with men

Project Summary Nigeria is one of the six countries with half of the global burden of youth with HIV. HIV prevalence among young men who have sex with men (YMSM) and young transgender women (YTW), ages 15-24 is over six-fold that of the general population of youth. Furthermore, across risk groups, youth have disproportionately worse HIV care outcomes in comparison to adults. There are challenges to treatment engagement and viral suppression among YMSM and YTW. While adult HIV care routinely begins at age 15, youth-adapted programs to support successful care engagement are rare, particularly for YMSM and YTW, who typically prefer to receive care in multipurpose key population-focused community-based centers, which often lack evidence-driven, youth-specific interventions that include psychosocial and medication adherence support for best outcomes. This preference for key population-focused community centers is rational given the country’s unfavorable social milieu which promotes social stigma, lack of disclosure, and low social support, and in the context of a legal environment which criminalizes same-sex relationships. Evidence-based and scalable approaches, incorporating preferences for community centers, are needed to have the greatest impact on ART outcomes among YMSM and YTW in Nigeria. Thus, we propose to adapt and test the Intensive Combination Approach to Rollback the Epidemic in Nigeria (iCARE Nigeria), to improve HIV treatment engagement, medication adherence, and viral suppression among YMSM and YTW where they receive care. The iCARE Nigeria model uses evidence-based and youth-specific approaches, including peer navigation and daily text message reminders in combination. iCARE Nigeria has demonstrated efficacy in a general population of youth with HIV in a traditional HIV clinic at the University of Ibadan, Nigeria. In this study, we will expand it to YMSM and YTW cared for in community centers using a community and outreach-based delivery approach. Our goal is to develop a practical and scalable enhancement to HIV treatment for YMSM and YTW where they receive care. Our aims are to: 1) adapt the iCARE Nigeria HIV clinic-based intervention to a community-based outreach approach for YMSM and YTW ages 15-24 living with HIV in Ibadan, Nigeria; 2) test the adapted iCARE intervention for initial efficacy, feasibility, satisfaction, and acceptability among YMSM and YTW and 3) evaluate implementation indicators based on RE-AIM (reach, adoption, implementation, maintenance) to inform widespread dissemination and scalability of the adapted iCARE Nigeria intervention.

项目概要 尼日利亚是艾滋病毒感染率占全球青年负担的六个国家之一。 15-24 岁的年轻男男性行为者 (YMSM) 和年轻变性女性 (YTW) 是其六倍多 此外，在所有风险群体中，青年人的情况尤其糟糕。 与成人相比，艾滋病毒护理结果存在治疗参与度和病毒感染方面的挑战。 YMSM 和 YTW 之间的抑制虽然成人艾滋病毒护理常规从 15 岁开始，但适合青少年。 支持成功护理参与的计划很少见，特别是对于 YMSM 和 YTW 而言，他们通常 更喜欢在以重点人群为中心的多功能社区中心接受护理，这些中心往往缺乏 以证据为导向、针对青少年的干预措施，包括社会和药物依从性支持 考虑到该国的情况，这种对以重点人群为中心的社区中心的偏好是合理的。 不利的社会环境助长了社会耻辱、缺乏信息披露和低社会支持， 将同性关系定为刑事犯罪的法律环境背景基于证据且可扩展。 需要结合社区中心偏好的方法对 ART 产生最大影响 因此，我们建议调整和测试强化组合。 遏制尼日利亚流行病的方法（iCARE尼日利亚），以提高艾滋病毒治疗参与度， YMSM 和 YTW 接受护理时的药物依从性、病毒抑制。 尼日利亚模式采用基于证据和针对青年的方法，包括同伴导航和每日文本 iCARE 尼日利亚已在广大青少年群体中展现出功效。 在尼日利亚伊巴丹大学的传统 HIV 诊所中感染 HIV 的患者在这项研究中，我们将其扩展到 YMSM。 和 YTW 使用基于社区和外展的交付方法在社区中心提供护理 我们的目标。 是为 YMSM 和 YTW 开发一种实用且可扩展的 HIV 治疗增强方案，让他们接受治疗 我们的目标是： 1) 将 iCARE 尼日利亚艾滋病毒诊所干预措施调整为基于社区的干预措施。 针对尼日利亚伊巴丹 15-24 岁艾滋病毒感染者 YMSM 和 YTW 的外展方法 2) 测试改编后的方法； iCARE 干预措施以提高 YMSM 和 YTW 的初步功效、可行性、满意度和可接受性；3) 基于RE-AIM（覆盖、采用、实施、维护）评估实施指标 为经过调整的 iCARE 尼日利亚干预措施的广泛传播和可扩展性提供信息。