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: 8786089
• 负责人: FRED M SSEWAMALA
• 金额: $ 74.53万
• 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 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8786089
• 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; HIV-infected adolescents; 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; Sampling; Savings; Seeds; Self Efficacy; 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; sexual risk taking; 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.

描述（由申请人提供）：拟议的研究考察了与创新干预措施相关的影响和成本，该干预措施旨在提高 HIV 感染 (HIV+) 青少年对 HIV 治疗的依从性（以下简称 Suubi+Adherence）。 Suubi+Adherence 的基础是之前对艾滋病孤儿 Suubi-Uganda 进行过测试的有效经济赋权干预措施，并借鉴了资产理论和之前的依从性研究。 Suubi+Adherence 旨在：1) 促进贫困艾滋病毒+青少年及其家庭的创收活动（也称为微型企业），以便有足够的收入来满足与将艾滋病毒作为一种慢性疾病进行管理相关的特定财务需求； 2) 为坚持抗逆转录病毒治疗（ART）提供支持。乌干达和撒哈拉以南非洲 (SSA) 大部分地区的研究表明，受艾滋病毒影响尤为严重的一个群体是经济上处于弱势的儿童。对于这一人群来说，坚持治疗方案可能需要一定程度的经济稳定，而许多年轻人却没有经历过。事实上，人们普遍提到的不依从性原因本质上是经济原因，例如缺乏药物资源、缺乏前往诊所就诊的交通以及食物和营养补充剂。贫困儿童不太可能坚持接受抗逆转录病毒治疗和其他与健康相关的治疗方案。然而，迄今为止，还没有任何依从性干预措施集中于潜在的经济驱动因素，这可能有助于解释为什么对贫困的艾滋病病毒感染青少年的依从性干预措施的结果最多只能产生小到中等的影响。拟议的研究将随机分配 736 名 HIV + 青少年（研究开始时年龄为 12 至 15 岁），接受乌干达南部 Rakai、Masaka 和 Lwengo 地区（受 HIV/艾滋病影响严重的地区）32 个卫生诊所的护理，接受两种研究条件之一：Suubi+坚持与强化标准护理 (SOC)。评估将在基线以及干预开始后 12、24、36 和 48 个月进行。更具体地说，我们将：1) 检查 Suubi+Adherence 干预对 HIV + 青少年对 HIV 治疗方案关键依从性的影响，包括：参与者获得和补充处方药物以及遵守规定的每日用药常规的能力：a) 不跳过剂量，b) 在正确的时间服药，c) 参与者的健康知识和健康行为（例如，遵守医疗预约、遵循以下规则） 营养建议），d）CD4 和 HIV 相关生物标志物（CD4 T 细胞计数和病毒载量）； 2）探索Suubi+坚持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、个人对药物的信念、绝望、未来计划和愿望、自我效能）； 3) 检查与 Suubi+Adherence 相关的成本。该研究将增进知识并为旨在提高SSA等资源匮乏地区的HIV阳性青少年接受HIV治疗的计划的制定提供信息。该研究将为经济赋权计划对短期和长期影响的影响提供重要证据。