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方案的一个关键障碍是缺乏针对青少年的艾滋病毒流行率和服务使用数据。人口调查和国家报告没有承认青春期是一个不同的发展阶段；相反，青少年与青壮年一起被归类为青年(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，与青壮年不同的是，青春期是一个过渡期，其特点是发生了重大的生理、智力和心理社会变化。因此，青春期中后期(即15-19岁)感染艾滋病毒的青年(即15-19岁)的检测、治疗和护理需求很可能与年轻人(即20-24岁)的检测、治疗和护理需求不同。这项研究侧重于青少年，因为尽管研究表明这一群体面临很高的感染风险，但对识别感染者并将其与护理联系起来的有效方法重视不够。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，为这一群体提供的服务不足。很少有青少年进行艾滋病毒检测，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也知之甚少。作为一个群体，青少年通常不会获得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正在接受艾滋病毒护理，因为肯尼亚没有系统追踪那些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，与年长的人相比，年轻的感染者参加护理的可能性较小，这表明需要制定更普遍的识别、护理和治疗策略。拟议的研究背景是Nyanza省的Siaya区，这是肯尼亚艾滋病毒流行率最高的地区。卢奥族占锡亚区人口的90%以上，是肯尼亚所有族裔中艾滋病毒和孤儿流行率最高的。这两项具体研究的目的是：1)估计锡亚区15-19岁青少年中艾滋病毒的流行率，以及感染者从事护理工作的比例。研究人员将使用两个最新和可靠的基于人口的数据来源来估计锡亚族青少年的流行率，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。这些数据将首次对受感染的青少年和接受护理的青少年之间的差距提供可信的估计。由于预计差距很大，这一新信息可以将青少年艾滋病毒护理提升为公共议程上的优先事项，并作为干预研究的基线。2)确定确定艾滋病毒阳性青少年并将其与护理联系起来的障碍和最有希望的战略。调查人员将对主要线人进行定性约谈 在至少15家具有丰富经验的诊所对青少年进行测试并将其与Siaya的护理联系起来 地区。他们还将采访多达80名15-19岁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者的看法。这项R21研究针对的是在很大程度上被艾滋病毒研究人员和政策制定者忽视的高度脆弱的人群。

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.