Suubi+Adherence-R2: Examining the longitudinal HIV treatment adherence among youth living with HIV (YLHIV) transitioning into young adulthood

项目摘要 这项相互竞争的Suubi+依从性研究(R01HD074949)将检查纵向HIV 抗逆转录病毒疗法(ART)的坚持和相关结果，以及保护健康的潜在机制 参与循证家庭经济研究的青年艾滋病病毒感染者的行为 在乌干达开展赋权(收费)干预，目前正在过渡到青壮年。撒哈拉以南非洲 (SSA)的艾滋病毒流行率是世界上最高的。在乌干达，一个贫穷的SSA国家感染艾滋病毒最严重， 年，青少年和青壮年(15至24岁)病毒载量抑制的流行率为44.9%。 女性占32.5%，男性占32.5%。在六年(2012-2018)中，Suubi+依从性研究前瞻性地进行了跟踪 702名YLHIV(登记时年龄在10岁至16岁之间)被随机分配到乌干达39家诊所的两个研究小组：1) 由支撑式标准护理(BSOC)组成的控制臂和2)由BSOC和 费用干预。研究结果指出，优越的短期病毒抑制和积极的儿童健康 心理健康在干预组中发挥作用。此次续订(Suubi+坚持-第二轮)建议 研究结果是否会一直保持到青年期，这是一个非常脆弱的过渡期， 特别是在坚持艾滋病毒治疗、认知发展、心理健康、性风险承担等领域 行为和滥用酒精/药物。续订(2020-2025)将基于Suubi+遵从性研究，以 在SSA的发育期进行规模最大、运行时间最长的YLHIV研究之一 通过深刻的生理和心理成熟，取得发展的转折性里程碑。在接下来的这个 阶段，我们将添加一个定性部分，以检查参与者对费用计划的体验 作为长期影响。创新地，我们还将评估费用对认知功能的影响。这项研究 具体目标是：目标1.检查Suubi+依从性干预措施对HIV病毒的长期影响 抑制(主要结果)，并探讨干预对关键艾滋病毒治疗的长期影响 YLHIV的坚持结果，包括参与者获得和补充处方药的能力，坚持 按规定的日常用药程序，并从事艾滋病毒护理；目标2.阐明 Suubi+坚持干预潜在的变化机制，包括：a)经济稳定、性风险-- 采取行为，坚持自我效能；b)认知功能；c)心理健康功能；d)年轻 成人过渡和社会支持；目标3.定性审查--前瞻性和回溯性：a)多方面的 Suubi+坚持干预后影响参与者维持干预收益的水平因素 (B)参与者参与干预的经历(回顾)，包括多次干预 可能影响他们参与计划和在以下方面做出决策的水平因素 对ART坚持；目的4.检查Suubi+坚持干预的长期成本-效果。 这项研究与美国国立卫生研究院艾滋病研究办公室的优先事项一致。

PROJECT ABSTRACT This competing renewal to Suubi+Adherence study (R01HD074949) will examine the longitudinal HIV antiretroviral therapy (ART) adherence and related outcomes, and the potential mechanisms of protective health behaviors among youth living with HIV (YLHIV) who participated in an evidence-based family economic empowerment (FEE) intervention in Uganda and are now transitioning into young adulthood. Sub-Saharan Africa (SSA) has the highest HIV prevalence rate in the world. In Uganda, a poor SSA country hardest hit with HIV, the prevalence of viral load suppression among adolescents and young adults (15 to 24 years old) is 44.9% for females and 32.5% for males. For six years (2012-2018), the Suubi+Adherence study prospectively followed 702 YLHIV (aged 10 to 16 years at enrollment) randomized to two study arms across 39 clinics in Uganda: 1) control arm consisting of bolstered standard of care (BSOC) and 2) intervention arm consisting of BSOC and a FEE intervention. Study findings pointed to superior short-term viral suppression and positive child health and mental health functioning among the intervention arm. This renewal (Suubi+Adherence-Round 2) proposes to examine whether the results are maintained through young adulthood, an incredibly vulnerable transition period, particularly in areas of adherence to HIV treatment, cognitive development, mental health, sexual risk taking behaviors and alcohol/drug misuse. The renewal (2020-2025) will build on the Suubi+Adherence study to conduct one of the largest and longest running studies of YLHIV in SSA during a developmental period marked by profound biological and psychological maturation, and development transitional milestones. In this next phase, we will add a qualitative component to examine participants' experiences with the FEE program as well as long-term effects. Innovatively, we will also assess the impact of the FEE on cognitive functioning. The study specific aims are: Aim 1. To examine the long-term impact of the Suubi+Adherence intervention on: HIV viral suppression (primary outcome) and to explore the long-term impact of the intervention on key HIV treatment adherence outcomes for YLHIV, including participants' ability to access and refill prescribed medication, adhere to prescribed daily medication routines, and engage in HIV care; Aim 2. To elucidate the long-term effects of the Suubi+Adherence intervention on potential mechanisms of change, including: a) economic stability, sexual risk- taking behavior, adherence self-efficacy; b) cognitive functioning; c) mental health functioning; and d) young adult transitions and social support; Aim 3. To qualitatively examine– prospectively and retrospectively: a) multi- level factors affecting participants' maintenance of intervention benefits since Suubi+Adherence intervention initiation (prospectively); and b) participants' experiences with the intervention (retrospectively), including multi- level factors that may have influenced their engagement with the program and their decision-making in regard to ART adherence; Aim 4. To examine the long-term cost-effectiveness of the Suubi+Adherence intervention. The study is aligned with the National Institutes of Health Office of AIDS Research priorities.