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HIV感染（HIV+）青少年对HIV治疗的依从性（以下简称Suubi+依从性）。Suubi+Adherence是由一种有效的经济赋权干预措施所提供的信息，该干预措施以前曾在艾滋病孤儿中进行过测试，Suubi-Uganda，并借鉴了资产理论和以前的依从性研究。Suubi+Adherence旨在：1）促进为艾滋病毒阳性的贫困青少年及其家庭开展创收活动-也称为微型企业，以便有足够的收入来满足将艾滋病毒作为一种慢性疾病进行管理的具体财务需求; 2）为坚持抗逆转录病毒疗法提供支助。来自乌干达和撒哈拉以南非洲大部分地区的研究表明，受艾滋病毒影响最大的一个群体是经济脆弱的儿童。对于这一人群，坚持治疗方案可能需要一定程度的经济稳定，而许多年轻人没有经历过。事实上，不遵守的常见原因是经济性质的，如缺乏药物资源，参加诊所预约的交通工具，以及食品和营养补充剂。贫困儿童不太可能坚持抗逆转录病毒疗法和其他与健康有关的疗法。然而，到目前为止，还没有任何依从性干预措施关注根本的经济驱动因素，这可能有助于解释为什么对贫困的艾滋病毒阳性青少年进行依从性干预的结果充其量只能产生小到中等的影响。拟议的研究将在乌干达南部Rakai、马萨卡和Lwengo地区（受艾滋病毒/艾滋病影响严重的地区）的32个卫生诊所接受治疗的736名艾滋病毒阳性青少年（进入研究时年龄为12至15岁）随机分配至两种研究条件之一：Suubi+依从性vs.支持标准治疗（SOC）。将在基线以及干预开始后12、24、36和48个月进行评估。更具体地说，我们将：1）检查Suubi+依从性干预对HIV+青少年关键依从性HIV治疗方案结局的影响，包括：参与者获取和补充处方药物并保持处方每日用药常规的能力：a）不跳过剂量，B）在正确的时间服用剂量，c）参与者的健康知识和健康行为（例如，保持医疗预约，遵循营养建议），d）CD 4和HIV相关生物标志物（CD 4 T细胞计数和病毒载量）; 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，性冒险行为，对药物的个人信念，绝望，未来计划和愿望，自我效能）;和3）检查与Suubi+依从性相关的成本。这项研究将促进知识的发展，并为旨在提高资源匮乏地区（如SSA）艾滋病毒阳性青少年对艾滋病毒治疗的依从性的计划的制定提供信息。这项研究将提供有关经济赋权计划对短期和长期影响的重要证据。 公共卫生相关性：这项拟议中的研究代表了对一种创新的理论指导干预措施的影响和成本的首次评估，这种干预措施旨在提高艾滋病毒感染青少年对艾滋病毒治疗的依从性。该研究为贫困的艾滋病毒阳性青少年实施了一项储蓄主导的微型企业计划，以便有足够的收入来满足将艾滋病毒作为慢性疾病管理的具体需求。