Evaluating a Youth focused economic empowerment approach to HIV Treatment

评估以青年为中心的艾滋病毒治疗经济赋权方法

• 批准号: 8432292
• 负责人: FRED M SSEWAMALA
• 金额: $ 78.57万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8432292
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Adolescent; Affect; Africa South of the Sahara; Age; Appointment; Behavior; Belief; Biological Markers; Blood Tests; CD4 Positive T Lymphocytes; Caregivers; Caring; Cell Count; Child; Chronic Disease; Clinic; Development; Diet; Dose; Economics; Family; Feeling hopeless; Food; Food Supplements; Funding; Future; Goals; HIV; Health; Health Personnel; Health behavior; Healthcare; Impact evaluation; Income; Intervention; Intervention Studies; Knowledge; Medical; Nature; Nutritional; Orphan; Outcome; Participant; Personal Behavior; Persons; Pharmaceutical Preparations; Population; Poverty; Program Development; Psyche structure; Randomized; Recommendation; Regimen; Research; Resources; Risk-Taking; Sampling; Savings; Seeds; Self Efficacy; Sex Functioning; Testing; Time; Training Support; Transportation; Treatment Protocols; Uganda; Viral Load result; Work; Youth; antiretroviral therapy; cost; design; dietary supplements; empowerment; experience; follow-up; health literacy; improved; innovation; medical appointment; meetings; member; next generation; post intervention; programs; standard of care; theories; treatment adherence

DESCRIPTION (provided by applicant): The proposed study examines the impact and cost associated with an innovative intervention to increase adherence to HIV treatment for HIV-infected (HIV+) adolescents (hereafter Suubi+Adherence). Suubi+Adherence is informed by an efficacious economic empowerment intervention previously tested with AIDS-orphaned children, Suubi-Uganda, and draws from Asset-Theory and previous adherence studies. Suubi+Adherence aims to: 1) promote income-generating activities -- also known as microenterprises -- for poor HIV+ adolescents and their families so that there is sufficient income to meet the specific financial needs associated with managing HIV as a chronic illness and; 2) provide support for adherence to antiretroviral therapy (ART). Studies from Uganda, and much of sub-Saharan Africa (SSA) indicate that one group disproportionately affected by HIV is economically vulnerable children. For this population, adherence to treatment regimens may require a level of economic stability that many youth do not experience. Indeed, the commonly cited reasons for non-adherence are economic in nature, such as lack of resources for medication, transportation to attend clinic appointments, and food and nutritional supplements. Poor children are less likely to adhere to ART and other health-related regimens. Yet, to date, no adherence interventions have focused on the underlying economic drivers, which might help explain why results of adherence interventions with HIV+ adolescents in poverty have had small to moderate effects at best. The proposed study will randomly assign 736 HIV+ adolescents (ages 12 to 15 years at study entry) under the care of 32 health clinics in Rakai, Masaka, and Lwengo Districts of southern Uganda - districts heavily affected by HIV/AIDS - to one of two study conditions: Suubi+Adherence vs. bolstered standard of care (SOC). Assessments will be conducted at baseline, and 12, 24, 36, and 48-months post-intervention initiation. More specifically, we will: 1) examine the impact of the Suubi+Adherence intervention on key adherence to HIV treatment regimen outcomes for HIV+ adolescents, including: participants' ability to access and refill prescribed medication and keep to prescribed daily medication routines: a) not skipping doses, b) taking doses at the right times, c) participants' health literay and health behaviors (e.g. keeping medical appointments, following nutritional recommendations), d) CD4, and HIV-related biomarkers (CD4 T-cell count and viral load); 2) explore the impact of the Suubi+Adherence intervention on potential mechanisms of protective health behaviors, knowledge, and beliefs (e.g. financial stability, sexual risk-taking behavior, personal beliefs about medication, hopelessness, future plans and aspirations, self-efficacy); and 3) examine the costs associated with the Suubi+Adherence. The study will advance knowledge and inform the development of programs aimed at increasing adherence to HIV treatment for HIV+ adolescents in low-resource regions such as SSA. The study will provide crucial evidence about the effects of an economic empowerment program on short, and long-term impacts. PUBLIC HEALTH RELEVANCE: The proposed study represents the first evaluation of the impact and cost associated with an innovative theoretically-guided intervention to increase adherence to HIV treatment for HIV- infected adolescents. The study applies a savings-led microenterprises program for poor HIV+ adolescents so that there is sufficient income to meet the specific needs associated with managing HIV as a chronic illness.

描述（由申请人提供）：拟议的研究检查了与创新干预措施相关的影响和成本，以增加对HIV感染的HIV治疗（HIV+）青少年（以下称Suubi+依从性）。 Suubi+依从性是由先前与艾滋病子宫（Suubi-uganda）进行了有效的经济授权干预措施来告知的，并从资产理论和以前的依从性研究中获取。 Suubi+依从性的目的是：1）促进较差的HIV+青少年及其家人促进创收活动（也称为微型企业），以便有足够的收入来满足与将HIV作为慢性疾病管理和管理HIV相关的特定财务需求； 2）为遵守抗逆转录病毒疗法（ART）提供支持。乌干达和撒哈拉以南非洲（SSA）的研究表明，受艾滋病毒影响不成比例的群体在经济上是脆弱的儿童。对于这种人群，遵守治疗方案可能需要许多青年没有经历的经济稳定。实际上，不遵守的普遍原因是经济性质，例如缺乏药物资源，参加诊所任命的运输以及食品和营养补充剂。贫困儿童不太可能遵守艺术和其他与健康有关的方案。然而，迄今为止，还没有遵守干预措施集中在潜在的经济驱动因素上，这可能有助于解释为什么与贫困中艾滋病毒+青少年依从性干预的结果充其量最多具有小到中等影响。拟议的研究将在Rakai，Masaka和南部乌干达的Lwengo地区的32家卫生诊所的护理下随机分配736名HIV+青少年（在研究入学期间为12至15岁） - 受HIV/AIDS的较大影响，受HIV/AID的影响，受到了两个研究条件：Suubi+ Adherence+ Adherence vs. Adherence vs. bollaster boldersed Care（Socsered Care（Soc））。评估将在基线以及12、24、36和48个月的干预后开始。 More specifically, we will: 1) examine the impact of the Suubi+Adherence intervention on key adherence to HIV treatment regimen outcomes for HIV+ adolescents, including: participants' ability to access and refill prescribed medication and keep to prescribed daily medication routines: a) not skipping doses, b) taking doses at the right times, c) participants' health literay and health behaviors (e.g. keeping medical appointments, following营养建议），d）CD4和与HIV相关的生物标志物（CD4 T细胞计数和病毒载荷）； 2）探索Suubi+依从性干预对保护性健康行为，知识和信念的潜在机制的影响（例如，财务稳定，性冒险行为，对药物的个人信念，绝望，未来的计划和愿望，自我效能）； 3）检查与Suubi+依从性相关的成本。这项研究将提高知识并为旨在增加对诸如SSA等低资源地区HIV+青少年艾滋病毒治疗的计划的发展提供信息。该研究将提供有关赋予经济能力计划对短期和长期影响的影响的重要证据。 公共卫生相关性：拟议的研究代表了与创新的理论指导干预措施相关的影响和成本的首次评估，以增加对艾滋病毒感染青少年的艾滋病毒治疗的依从性。该研究针对较差的艾滋病毒+青少年采用了储蓄领导的微型企业计划，因此有足够的收入来满足与将艾滋病毒视为慢性病相关的特定需求。