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

上报摘要/摘要 青少年是全球艾滋病毒流行的核心。他们极易感染艾滋病毒 对于携带艾滋病毒(ALHIV)的青少年来说，健康结果不佳的风险不成比例 在整个艾滋病毒护理连续体系中。保留率、抗逆转录病毒治疗的依从性(ART)和病毒 在ALHIV中，抑制率(VS)低得令人震惊，值得紧急关注。青春期是一种 身体和心理快速发展的时期，即青年从童年进入成年的时期 并经历多重挑战以及成长、创造力和学习的机会。青年 在不利条件下进入这一时期的人没有做好准备来应对与 可能致命的、污名化的、可传播的感染以及采取积极的、寻求健康的必要性 行为举止，从事健康服务，坚持日常艺术养生。在高流行率 像莫桑比克这样的国家，在这个脆弱的发展阶段，艾滋病毒携带者的负担 脆弱的卫生系统和新出现的针对ALHIV的差异化服务进一步加剧了这种情况 交付(DSD)模型。与此同时，开发和测试的具体干预措施很少 这解决了艾滋病病毒的需求。作为回应，我们建议开发和测试一种文化- 以青少年为重点的适当、与环境相关且有理论基础的多组件 在莫桑比克赞比西亚省的ALHIV人群中实施干预战略，Combinado。用一个人类- 以设计为中心的方法，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项由四个国家组成的联合干预战略 组成部分：1)ALHIV同行导航和支持，2)青少年友好服务，3)移动健康 技术，以及4)健康通信消息(阶段1)。在第二阶段，我们建议评估 综合战略在艾滋病毒护理连续统一体的三个里程碑上的有效性：(A) 在HIV护理中的保留，(B)抗逆转录病毒治疗的依从性，和(C)在ALHIV中的VS，使用随机分组 对照试验设计。这项研究建立在ICAP与哥伦比亚大学之间的长期合作伙伴关系上 大学、莫桑比克卫生部和其他当地利益攸关方，所有这些都旨在改善 在对这一高度脆弱的人群进行连续护理的过程中， 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.