Promoting Engagement in HIV Services among Adolescents in Kenya

描述（由申请人提供）：制定有效的青少年艾滋病毒服务计划的一个关键障碍是缺乏青少年特定的艾滋病毒流行率和服务使用数据。人口调查和国家报告不承认青春期是一个独特的发展阶段;相反，青少年与年轻的成年人一起被称为青年（即，15-24岁）。现有数据表明，全世界估计有500万青年感染艾滋病毒，其中75%生活在撒哈拉以南非洲。然而，与青年期相比，青春期是一个过渡时期，其特点是生理、智力和心理社会发生重大变化。因此，在青春期中后期（即，15-19奥尔兹）可能与年轻人的那些人（即，20-24岁）。这项研究以青少年为重点，因为尽管研究表明这一群体面临着很高的感染风险，但没有充分重视查明感染者并将其与护理联系起来的有效方法。虽然人们对如何让青少年参与艾滋病毒服务知之甚少，但有证据表明，现有的服务对这一群体来说是不够的。很少有青少年进行艾滋病毒检测，而且对全球迫切需要艾滋病毒护理和治疗的青少年接受这些服务的比例知之甚少。作为一个群体，青少年通常不接受提供者发起的艾滋病毒检测和咨询，除非他们怀孕或健康状况非常差。目前尚不清楚有多少青年人正在接受艾滋病毒护理，因为在肯尼亚，没有任何系统跟踪检测呈阳性并被转介接受护理的人与护理之间的联系。然而，研究表明，与老年人相比，年轻感染者接受护理的可能性较小，这表明需要制定更普遍的识别、护理和治疗战略。拟定的研究环境是尼扬扎省的锡亚亚区，这是肯尼亚艾滋病毒流行率最高的地区。卢奥人占锡亚亚区人口的90%以上，是肯尼亚所有族裔群体中艾滋病毒和孤儿发病率最高的群体。2个具体的研究目标是：1）估计锡亚亚区15-19岁青少年的艾滋病毒流行率和从事护理的感染者比例。研究人员将使用两个最近和可靠的基于人口的数据来源来估计锡亚亚青少年的流行率，并使用提供者数据来估计接受和坚持艾滋病毒服务的比例。这些数据将首次可靠地估计青少年感染者与接受护理者之间的差距。由于预计差距差距很大，这一新信息可以将青少年艾滋病毒护理提升为公共议程的优先事项，并作为干预研究的基线。2)查明艾滋病毒呈阳性的青少年的障碍和最有希望的战略，并将其与护理联系起来。调查人员将对关键线人进行定性访谈 在锡亚亚，至少有15个诊所在检测和联系青少年与护理方面具有丰富的经验， 区的他们还将采访多达80名15-19岁的艾滋病毒阳性青少年及其父母或监护人，了解他们对参与艾滋病毒服务的障碍和可能的促进因素的看法。这项R21研究针对的是艾滋病毒研究人员和政策制定者在很大程度上忽视的高度脆弱人群。

DESCRIPTION (provided by applicant): A key obstacle in the development of effective adolescent HIV services programs is the lack of adolescent- specific HIV prevalence and service use data. Population surveys and country reports do not recognize adolescence as a distinct developmental stage; instead adolescents are grouped with young adults and called youth (i.e., 15-24 years). Available data indicate that an estimated 5 million youth are HIV infected worldwide and 75% of them live in sub-Saharan Africa. However, in contrast to young adulthood, adolescence is a period of transition characterized by major physiological, intellectual and psychosocial changes. Thus, the testing, treatment, and care needs of HIV-infected youth in mid to late adolescence (i.e., 15-19 year olds) are likely to differ substantiall from those of young adults (i.e., 20-24 years). This study focuses on adolescents because, although research indicates that this group faces a high risk of infection, inadequate attention has been paid to effective ways to identify and link the infected to care. While little is known about how to engage adolescents in HIV services, evidence suggests that available services are insufficient for this group. Few adolescents test for HIV and little is known about the proportion of adolescents in urgent need of HIV care and treatment globally receiving these services. As a group, adolescents do not routinely access provider-initiated HIV testing and counseling unless they are pregnant or in very poor health. It is not known how many youth are receiving HIV care because there are no systems that track linkage to care among those who test positive and are referred to care in Kenya. Research, however, suggests that younger infected individuals are less likely to be enrolled in care than older individuals, suggesting the need to develop more universal strategies for identification, care and treatment. The proposed study setting is Siaya District in Nyanza Province, which is the region with the highest HIV prevalence in Kenya. The Luos, comprising more than 90% of the Siaya District population, have the highest HIV and orphan prevalence of all ethnic groups in Kenya. The 2 specific study aims are: 1) To estimate HIV prevalence among Siaya District adolescents aged 15-19 years and the proportion of those infected engaged in care. Researchers will use two recent and reliable population-based data sources to estimate prevalence among Siaya adolescents and provider data to estimate the proportion receiving and adhering to HIV services. These data will provide the first credible estimate of the size of the gap between adolescents infected and those receiving care. Because the gap is expected to be large, this new information can elevate adolescent HIV care as a priority on the public agenda and serve as a baseline for intervention research. 2) To identify the obstacles and most promising strategies to identify and link HIV positive adolescents to care. Investigators will conduct qualitative interviews with key informants in at least 15 clinics with substantial experience testing and linking adolescents to care in Siaya District. They will also interview up to 80 HIV positive adolescents 15-19 years and their parent or guardian about their perceptions of barriers and possible facilitators to engagement in HIV services. This R21 research study addresses a highly vulnerable population that has been largely neglected by HIV researchers and policy makers.