Bridges-Round 2: Evaluating the Long-term Impact of a Family Economic Empowerment Intervention on HIV Risk Prevention and Care Continuum Outcomes among Orphaned Youth Transitioning to Young Adulthood

Bridges-Round 2：评估家庭经济赋权干预措施对过渡到青年时期的孤儿青少年的艾滋病毒风险预防和护理连续结果的长期影响

• 批准号: 10405349
• 负责人: Proscovia Nabunya
• 金额: $ 63.01万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-17 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10405349
• 关键词: 14 year old; 16 year old; AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adolescent; Adolescent and Young Adult; Affect; Africa South of the Sahara; Age; Alcohols; Behavior; Biological Markers; Caring; Childhood; Continuity of Patient Care; Cost-Benefit Analysis; Costs and Benefits; Data; Development; Economics; Education; Effectiveness; Employment; Enrollment; Family; Future; Goals; Guide prevention; HIV; HIV Infections; HIV Seronegativity; HIV antiretroviral; HIV risk; Health; Health behavior; Home; Human immunodeficiency virus test; Incidence; Intervention; Knowledge; Life; Life Cycle Stages; Long-Term Effects; Male Circumcision; Marriage; Measures; Medical; Mental Health; Orphan; Outcome; Parents; Participant; Patient Self-Report; Perception; Performance; Personal Satisfaction; Persons; Policies; Population; Poverty; Prevalence; Prevention; Primary Schools; Program Sustainability; Public Health; Research; Resource-limited setting; Resources; Risk; Risk Behaviors; Risk-Taking; Rural; Schools; Sex Behavior; Sexual Health; Sexually Transmitted Diseases; Social Controls; Social support; Testing; Translating; Uganda; United States National Institutes of Health; Viral; Viral Load result; Well in self; Work; Youth; adverse childhood events; age group; alcohol misuse; base; behavioral health; behavioral outcome; boys; cohort; cost; drug misuse; early adolescence; economic evaluation; empowerment; experience; experimental study; girls; improved; innovation; longitudinal dataset; pre-exposure prophylaxis; premature; primary outcome; programs; reproductive; response; retention rate; scale up; secondary analysis; sexual risk behavior; sexual risk taking; social disadvantage; social stigma; success; therapy adherence; treatment adherence; young adult

PROJECT ABSTRACT Globally, adolescents and young adults (AYA; ages 14-29) represent 30% of HIV incidence cases among persons of reproductive age, with ~75% occurring in Sub Saharan Africa (SSA). HIV incidence rises rapidly in SSA, as AYA leave school (often prematurely) and migrate for work and marriage. Older adolescents are more likely to experiment with health compromising behaviors that increase their vulnerability to HIV and sexually transmitted infections (STIs). Young people orphaned by AIDS [YPoAIDS]), 80% of which live in SSA represent a particularly vulnerable and unique population. Most YPoAIDS in SSA experience immense hardships, including higher rates of HIV risk behavior and odds of HIV infection. These adversities cumulatively disrupt the developmental milestones for YPoAIDS and can compromise their health and emotional wellbeing. Notably, our team has had great success with implementing a 6-year, three-armed RCT that tested a family-based economic intervention, Bridges (R01HD070727), among 1,383 primary school going adolescents in rural Uganda (10-14 years of age at enrollment) who lost one or both parents to AIDS. With over 90% retention rate over a 6-year period (2012-2018), our findings show efficacy of this contextually-driven intervention significantly improving sexual health, school retention and performance, and mental health. Yet, two critical policy and programming questions related to HIV prevention and engagement in care continuum remain unaddressed: 1) longer-term effectiveness of Bridges across YPoAIDS’s life course is currently unknown but critically important because of unique vulnerabilities during the transition into young adulthood; and 2) self-reports of sexual health are unreliable, hence the need to integrate biomarkers to provide the most precise results of these highly relevant (but currently unknown) sexual health outcomes among our participants. Thus, the specific aims of the Bridges- Round 2 study are: Aim 1. Examine the long-term impact of Bridges on: HIV prevalence (measured via participant’s HIV status) (Primary outcome); and b) Explore in secondary analyses the long-term impact of Bridges on key developmental and behavioral outcomes (e.g., mental health, alcohol and drug misuse); Aim 2. Elucidate the long-term effects of Bridges on potential mechanisms of change, including: a) economic stability, viral suppression (for ALHIV); PrEP use (for HIV negative adolescents), medical male circumcision (for boys); and b) young adult transitions; Aim 3: Qualitatively investigate participants’ experiences with Bridges that may have influenced engagement with the program, sexual risk-taking decisions, financial behaviors; experiences with developmental transitions; and perceptions on program sustainability; Aim 4: To assess the long-term costs and benefits of Bridges using formal economic evaluation. Our long-term goal is to translate knowledge into sustainable, theoretically-guided prevention and treatment efforts that promote the wellbeing of AYA affected by HIV/AIDS across the life course, in low-resource settings.

项目摘要