CombinADO: a combination intervention strategy to improve health outcomes for adolescents living with HIV

项目摘要/总结 青少年是全球艾滋病毒流行病的核心。他们极易感染艾滋病毒 以及艾滋病毒感染青少年（ALHIV）--健康状况不佳的风险不成比例 在艾滋病护理连续体中。保留率、坚持抗逆转录病毒治疗（ART）和病毒感染 抑制（VS）在ALHIV中低得惊人，需要紧急关注。青春期是一个 青春期：青少年从童年到成年的身体和心理迅速发展的时期 并经历多重挑战，以及成长，创造力和学习的机会。青年 那些在不利条件下进入这一时期的人，没有准备好科普生活在 可能致命的、耻辱化的、传染性的感染，需要采取积极的、寻求健康的 行为，参与卫生服务，并坚持每日ART方案。高发 在莫桑比克这样的国家，在这个脆弱的发展阶段， 脆弱的卫生系统和新生的针对艾滋病毒的差别化服务进一步加剧了这一问题， 交付（DSD）模型。与此同时，制定和测试的具体干预措施很少 满足ALHIV的需求。作为回应，我们建议开发和测试一种文化- 适当的、与上下文相关的、有理论基础的、以一致性为重点的多分量 在莫桑比克赞比西亚的艾滋病毒防治联盟中实施干预战略CombinADO。利用人类- 我们将与ALHIV、护理人员、医疗保健提供者以及当地和 国家利益攸关方制定和试行这一CombinADO干预战略，包括四个方面： 组成部分：1）ALHIV同行导航和支持，2）方便残疾人的服务，3）移动健康 技术，以及4）健康传播信息（第1阶段）。在第二阶段，我们建议评估 CombinADO战略在艾滋病毒护理连续体的三个里程碑沿着的有效性： 保留在艾滋病毒护理，（B）抗逆转录病毒治疗的依从性，和（c）VS之间ALHIV使用一个集群随机 对照试验设计。这项研究建立在哥伦比亚大学ICAP与 大学，莫桑比克卫生部和其他当地利益攸关方，都旨在改善 疾病进程以及沿着对这一高度脆弱人群的持续护理的结果， 感染艾滋病毒的青少年。

UPROJECT ABSTRACT/ SUMMARY Adolescents are at the core of the global HIV epidemic. They are highly vulnerable to HIV acquisition and—for adolescents living with HIV (ALHIV)—at disproportionate risk for poor health outcomes across the HIV care continuum. Retention rates, adherence to antiretroviral treatment (ART), and viral suppression (VS) are alarmingly low among ALHIV, warranting urgent attention. Adolescence is a time of rapid physical and psychological development, when youth move from childhood to adulthood and experience multiple challenges as well as opportunities for growth, creativity, and learning. Youth who enter this period under adverse conditions are ill prepared to cope with the impact of living with a potentially fatal, stigmatized, transmissible infection and the need to adopt positive, health-seeking behaviors, engage with health services, and adhere to daily ART regimens. In high prevalence countries like Mozambique, the burden of living with HIV during this vulnerable developmental stage is further exacerbated by fragile health systems and nascent ALHIV-specific differentiated service delivery (DSD) models. At the same time, few specific interventions have been developed and tested that address the needs of ALHIV. In response, we propose to develop and test a culturally- appropriate, contextually-relevant, and theoretically-grounded adolescent-focused multicomponent intervention strategy, CombinADO, among ALHIV in Zambézia, Mozambique. Using a human- centered design approach, we will work with ALHIV, caregivers, health care providers, and local and national stakeholders to develop and pilot this CombinADO intervention strategy consisting of four components: 1) ALHIV peer navigation and support, 2) adolescent-friendly services, 3) mHealth technologies, and 4) health communication messaging (Phase 1). In Phase 2, we propose to evaluate the effectiveness of the CombinADO strategy on three milestones along the HIV care continuum: (a) retention in HIV care, (b) ART adherence, and (c) VS among ALHIV using a cluster randomized controlled trial design. The study builds on longstanding partnerships between ICAP at Columbia University, the Mozambique Ministry of Health and other local stakeholders, all aiming to improve the disease course as well as outcomes along the continuum of care for this highly vulnerable population, adolescents living with HIV.