Developing/Testing a Multi-level Interventions (SHIELD & IWC)

项目摘要/摘要 赞比亚是世界上艾滋病毒感染率最高的国家之一， （AGYW）尤其受到影响。先前的研究和倡议试图提供方便青年的服务 通过青少年抗逆转录病毒治疗（ART）诊所提供一系列服务，但这些诊所 由于失去隐私和与艾滋病毒有关的耻辱，为了弥补这一差距， 赞比亚卫生部、RTI国际、人口理事会和北卡罗来纳州大学 正在合作创建一个针对所有艾滋病毒感染者的综合健康护理（IWC）提供模式， AGYW，艾滋病毒阴性或不知道自己的状况（艾滋病毒-/u）和艾滋病毒阳性 (HIV+).我们将测试一个多层次的一揽子干预措施，将AGYW与定期护理的来源联系起来， 提供一个可持续的平台，以成功地进行定期艾滋病毒检测，并支持与 护理、保持护理和坚持抗病毒治疗。我们建议实现以下目标： UG3-1通过建立社区和青年咨询委员会， 研究，调整行为干预模块，并开发数据收集工具。 UG3-2招募AGYW建立抽样框架，进行离散选择实验， 系统地评估对艾滋病毒诊所服务的偏好（1 000名10至20岁的艾滋病毒感染者/u 和800名年龄在16至24岁之间的艾滋病毒阳性青少年妇女），以确保IWC诊所能够满足青少年妇女的需求。 UG3-3制定IWC万国表诊所服务交付和结构的标准操作程序（SOP）， 培训IWC万国表诊所员工，与青年顾问委员会合作，创造一个对青年友好的环境， 开展试点研究，评估执行进程（25 AGYW）。 UH3-1在第6个月和第12个月评估多层次干预措施对个人的有效性（艾滋病毒知识， 自我效能），人际（社会支持，减少耻辱），和卫生系统（IWC诊所）对艾滋病毒的水平 测试，保持在护理，和病毒载量抑制使用群集随机设计。 UH3-2在12个月时与临床工作人员和同行导航员进行深入访谈，以获得反馈 综合护理提供模式，以评估可持续性，记录最佳做法，并更新SOP， 支持扩大青年妇女咨询小组的综合服务。 UH3-3执行成本效益和预算分析，以评估和描述艾滋病毒护理的影响沿着 向国家合作伙伴和国际社会继续传播调查结果。 这种综合服务提供模式如果成功，还可以作为一个平台， 预防服务，包括针对高风险青少年妇女的接触前预防，目前正在 政府的考虑。

PROJECT SUMMARY/ABSTRACT Zambia has one of the highest incidences of HIV in the world, and adolescent girls and young women (AGYW) are particularly affected. Prior studies and initiatives attempted to provide youth-friendly services through adolescent antiretroviral therapy (ART) clinics that offer a range of services, but these clinics have faced challenges because loss of privacy and the stigma associated with HIV. To address this gap, the Zambian Ministry of Health, RTI International, the Population Council, and the University of North Carolina are collaborating to create an integrated wellness care (IWC) delivery model that targets all HIV-affected AGYW, both those that are HIV negative or do not know their status (HIV-/u) and those that are HIV positive (HIV+). We will test a multilevel package of interventions to connect AGYW with a source of regular care to provide a sustainable platform for successful implementation of regular HIV testing and support for linkage to care, retention in care, and adherence to antiviral treatment. We propose to pursue the following aims: UG3–1. Engage stakeholders by establishing community and youth advisory boards, conduct formative research, adapt modules for behavioral intervention, and develop data collection instruments. UG3–2. Recruit AGYW to establish a sampling frame and perform a discrete choice experiment to systematically evaluate preferences for HIV clinic-based services (1,000 HIV-/u AGYW aged 10 to 20 years and 800 HIV+ AGYW aged 16 to 24 years) to ensure the IWC clinic is tailored to AGYW's needs. UG3–3. Develop standard operating procedures (SOPs) for IWC clinic service delivery and structure, identify and train IWC clinic staff, engage the Youth Advisory Board to create a youth-friendly environment, and conduct a pilot study to evaluate implementation processes (25 AGYW). UH3–1. Assess efficacy at 6 and 12 months of the multilevel interventions at the individual (HIV knowledge, self-efficacy), interpersonal (social support, stigma reduction), and health system (IWC clinic) levels on HIV testing, retention in care, and viral load suppression using a cluster randomized design. UH3–2. Conduct in-depth interviews with clinical staff and peer navigators at 12 months to obtain feedback on the integrated care delivery model to assess sustainability, document best practices, and update SOPs to support scaling up of integrated services for AGYW. UH3–3. Perform cost-effectiveness and budget analysis to evaluate and describe impact along the HIV care continuum and disseminate findings to national partners and the international community. This integrated service delivery model, if successful, can also serve as a platform to implement additional preventive services, including pre-exposure prophylaxis (PrEP) for high-risk AGYW, which is currently under consideration by the government.