Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention.
Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention.
复制标题
DOI：
10.1136/bmjopen-2022-062134
复制
发表时间：
2022-10-31
期刊：
影响因子：
2.9
通讯作者：
John-Stewart, Grace
中科院分区：
文献类型：
--
作者：
Kohler, Pamela;Agot, Kawango;Njuguna, Irene N.;Dyer, Jessica;Badia, Jacinta;Jiang, Wenwen;Beima-Sofie, Kristin;Chhun, Nok;Inwani, Irene;Shah, Seema K.;Richardson, Barbra A.;Chaktoura, Nahida;John-Stewart, Grace
与成年人相比，青少年和青年艾滋病毒携带者(AYLHIV)在护理、坚持治疗和病毒抑制方面的保留率较低。分级护理是指根据需要的程度，将病人分配到日益密集的服务或“步骤”的过程。差异化护理，其中稳定的客户获得频率较低的服务，可以与分级护理相结合，以协调青年的需求和偏好，以促进最佳护理参与。这项混合型I类有效性实施分组随机试验旨在评估AYLHIV的数据信息阶梯式护理(DISC)干预。10-24岁的AYLHIV将在肯尼亚基苏木、霍马巴伊和米戈里县的24个艾滋病毒治疗机构接受护理。12家机构将随机接受椎间盘介入治疗，12家机构将提供标准护理。研究小组开发的临床分配工具将用于干预地点，根据后续丢失风险将AYLHIV分配到四个步骤之一：差异化护理、标准护理、咨询服务或强化支持服务。主要的临床结果是保留护理，特别是错过了访问(没有在30天内返回任何访问)和12个月的随访损失。执行结果以覆盖范围、有效性、采用、执行和维护框架为基础。错过访问的比例将使用按设施和参与者聚类的混合影响模型进行比较。这项研究已得到华盛顿大学机构审查委员会(STUDY00011096)、马塞诺大学伦理审查委员会(MUERC/00917/20)和肯尼亚国家科学、技术和创新委员会(444824)的批准。AYLHIV在法律允许的情况下为未成年人提供书面知情同意，或征得照顾者的许可。研究人员将与包括青年成员在内的社区咨询委员会合作，通过讨论、陈述、期刊出版物以及当地或国际会议传播成果。NCT05007717。
Adolescents and youth living with HIV (AYLHIV) have lower retention in care, adherence to treatment, and viral suppression compared with adults. Stepped care is a process by which clients are assigned to increasingly intensive services or ‘steps’ according to level of need. Differentiated care, in which stable clients access less frequent services, can be combined with stepped care to align needs and preferences of youth to promote optimal engagement in care. This hybrid type I effectiveness implementation cluster randomised trial aims to evaluate a data-informed stepped care (DiSC) intervention for AYLHIV. AYLHIV ages 10–24 receiving care at 24 HIV treatment facilities in Kisumu, Homabay and Migori counties in Kenya will be enrolled. Twelve facilities will be randomised to the DiSC intervention, and 12 will provide standard care. A clinical assignment tool developed by the study team will be used at intervention sites to assign AYLHIV to one of four steps based on risk for loss to follow-up: differentiated care, standard care, counselling services or intensive support services. The primary clinical outcome is retention in care, specifically missed visits (failure to return within 30 days for any visit) and 12-month loss to follow-up. Implementation outcomes are based on the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Proportions of missed visits will be compared using mixed effect models clustered by facility and participant. This study has been approved by the University of Washington Institutional Review Board (STUDY00011096), Maseno University Ethical Review Committee (MUERC/00917/20) and the Kenya National Commission for Science, Technology and Innovation (444824). AYLHIV provide written informed consent when legally permitted, or assent with caregiver permission for minors. Study staff will work with a Community Advisory Board, including youth members, to disseminate results via discussions, presentations, journal publications and local or international conferences. NCT05007717.
登录
查看更多内容
影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
6
作者：
Marcus R;Ferrand RA;Kranzer K;Bekker LG
通讯作者：
Bekker LG
影响因子：
3.8
作者：
Ford, Nathan;Migone, Chantal;Shubber, Zara
通讯作者：
Shubber, Zara