Scale it up: Effectiveness-implementation research to enhance HIV-related self-management among youth

摘要 尽管艾滋病毒传播率大幅下降，艾滋病毒携带者的寿命增加 艾滋病毒在过去十年中取得的成果，根据工具和干预措施应可实现的全部惠益 目前还没有在年轻人中实现，这在很大程度上是因为对这个年龄段采取了有效的干预措施 集团尚未形成规模。为了有效，青年必须充分参与每一年的干预。 艾滋病毒护理(治疗和预防)级联阶段：艾滋病毒检测、与护理挂钩、及时启动 护理、坚持不懈和坚持抗逆转录病毒护理。高危艾滋病毒阴性的年轻人需要始终如一地 参与预防策略，如PEP和/或PrEP，一致的安全性行为实践和 重复艾滋病毒检测。我们的U19项目-扩大规模-特别关注提高自我的过程 青年管理包括：1)确定对以下方面有效和有效的干预措施 改善基督教青年会和高危青少年的自我管理；2)多地点实施干预措施 有效地提高自我管理水平；3)自我管理的五个组成部分的评估 管理模式以及这些模式如何随时间变化，通过干预直接改进，并进行调解 干预效果。我们的团队也一直处于实施科学研究的前沿， 艾滋病毒预防和护理。我们积极致力于积极发展，超越简单的功效和 有效性随机对照试验。在《扩大规模》中提出的四个研究项目都涉及自我管理，将 通过采用三种类型的有效性来继续发展实施科学领域- 实施混合设计。这些研究进一步利用Aaron的探索、准备、 实施、可持续发展(EPIS)模型，以指导拟议的实施科学工作。我们的 建议的实施科学核心，加上我们的分析核心的成本效益专业知识，将 将重点放在“扩大规模”的核心概念上--采取有效的自我管理干预措施和 在保持有效性的同时，迅速将其付诸实践。扩大规模已经收集了研究成果 开发、测试并实践自我管理干预措施的团队，这些干预措施对 青年艾滋病毒预防和护理工作层出不穷。我们将通过以下方式实现这些目标：1)设计、实施和 评价基于五元自我管理模式的自我管理干预措施 迅速将有效的方案付诸实施；2)开发、部署和传播新的 具有较强理论基础的实施方法和实施分析；3)参与 与其他资助的U19一起寻找额外的机会，以推进实施科学和自我 管理科学。 项目摘要/摘要第200页

Abstract Despite the substantial declines in HIV transmission and increases in lifespan among those living with HIV achieved over the past decade, full benefits that should be possible based on the tools and interventions currently available have yet to be realized in youth, in large part because efficacious interventions for this age group have not been brought to scale. To be effective, youth must be fully engaged in interventions at every stage of the HIV care (treatment and prevention) cascades: HIV testing, linkage to care, timely initiation of care, persistence and adherence to antiretroviral care. At-risk HIV-negative youth need to be consistently engaged in prevention strategies such as PEP and/or PrEP as indicated, consistent safer sex practices and repeat HIV testing. Our U19 project - Scale It Up - specifically focuses on the process of improving self- management among youth including: 1) the identification of interventions that are efficacious and effective for improving self-management in YLH and at risk youth; 2) the multi-site implementation of an intervention shown to be efficacious in improving self-management; and 3) the assessment of the Five Components of Self- Management Model and how these vary over time, are directly improved by interventions, and mediate intervention effects. Our team has also been at the leading edge of implementation Science research related to HIV prevention and care. We are actively committed to aggressively moving beyond simple efficacy and effectiveness RCTs. The four Research Projects proposed in Scale It Up, all addressing self-management, will continue to develop the field of Implementation Science by employing three types of effectiveness- implementation hybrid designs. The studies further synergize by utilizing Aaron’s Exploration, Preparation, Implementation, Sustainment (EPIS) model to guide the proposed Implementation Science efforts. Our proposed Implementation Science Core, coupled with the cost effectiveness expertise of our Analytic Core, will be focused on the central notion of “Scale It Up” – taking efficacious self-management interventions and expeditiously moving them into practice while sustaining effectiveness. Scale It Up has assembled research teams who will develop, test, and bring to practice self-management interventions that positively impact the youth HIV prevention and care cascades. We will achieve these goals by: 1) Designing, conducting and evaluating self-management interventions grounded in the 5-component Self-Management Model and expeditiously moving effective programs into practice; 2) Developing, deploying and disseminating new methods for implementation and implementation analysis with a strong theoretical foundation; and 3) Engaging with the other funded U19s to identify additional opportunities to advance the implementation science and self- management science. Project Summary/Abstract Page 200