Transitioning from Pediatric to Adult HIV Care in Kenya

肯尼亚从儿科艾滋病毒护理转向成人艾滋病毒护理

• 批准号: 9205809
• 负责人: Grace John-Stewart
• 金额: $ 34.76万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9205809
• 关键词: 15 year old; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Africa; Age; Age-Years; Aging; Caregivers; Caring; Child; Childhood; Chronic Disease; Clinic; Cluster randomized trial; Collaborations; Computerized Medical Record; Data; Day Care; Disclosure; Disease; Drops; Enrollment; Focus Groups; Guilt; HIV; HIV Infections; HIV diagnosis; HIV-infected adolescents; Health Personnel; Health Policy; Health Status; Health system; Impact evaluation; Individual; Intervention; Interview; Kenya; Left; Modeling; Morbidity - disease rate; Mortality Decline; Namibia; Outcome; Parents; Pharmaceutical Preparations; Policy Maker; Prevalence; Protocols documentation; Provider; Research; Risk; Site; Staging; Surveys; Testing; Time; Training; Universities; Viral Load result; Visit; Vulnerable Populations; Washington; Youth; base; cofactor; coping; follow-up; improved; mortality; novel; pediatric human immunodeficiency virus; programs; retention rate; satisfaction; tool; transmission process; treatment center; treatment program; trend

Transitioning from pediatric to autonomous adult care is a vulnerable period when many adolescents drop out of HIV treatment programs. In contrast to trends in adult HIV infection where mortality is decreasing, rates of mortality among infected adolescents are increasing in many settings, underscoring the need for improved transitional care. Standardized transition tools, such as the US-based Got Transition model, have been developed to help children, caregivers, and providers plan for and execute transition across diverse chronic diseases; these tools are effective, and widely utilized in the US. However, transition tools are largely untested in settings with high HIV prevalence, and there are few systematic approaches to transition being used in Africa. Furthermore, effective transition can only occur alongside HIV disclosure, which can be delayed due to caregiver concerns about coping, guilt, or inadvertent loss of confidentiality. Transitional care and pediatric HIV disclosure are complementary urgent priorities for adolescents with HIV. We propose to adapt the Got Transition tool for use in Kenya where we have previously observed low rates of retention and disclosure among adolescents. We will utilize nationwide electronic medical records (KenyaEMR) to determine rates of successful transition in existing youth treatment programs, and determine predictors of successful transition (Aim 1). We will conduct interviews with adolescents, caregivers, healthcare workers and policy-makers to inform adaptation of the Got Transition tool for use in Kenya (Aim 2). Finally, we will test a combined intervention package consisting of the adapted transition tool plus a previously validated disclosure tool in a cluster randomized trial (Aim 3). This proposal builds on a >25 year HIV research collaboration between the University of Washington, the University of Nairobi, and the Kenya National AIDS/STI Control Programme (NASCP). Our collaboration with NASCOP enables us to conduct research that is impactful, locally relevant, and aligned with national programmatic approaches to facilitate implementation at scale. Adapting the established Got Transition model for use in Kenya and combining this with the disclosure toolkit is an efficient approach to address the continuum between pediatric to adult HIV care, and is expected to result in a novel product that can be implemented nationally. The study will additionally provide important evidence for a generalizable approach to improve disclosure and transition for adolescents with HIV infection throughout Africa.

从儿科过渡到成人自主护理是一个脆弱时期，许多青少年因此而辍学 艾滋病毒治疗计划。与死亡率下降的成人艾滋病毒感染趋势相反， 在许多情况下，受感染青少年的死亡率正在上升，这凸显了需要 改善过渡护理。标准化的过渡工具，例如美国的 Got Transition 模型，已经 旨在帮助儿童、看护者和提供者规划和执行跨不同领域的过渡 慢性疾病；这些工具非常有效，并在美国得到广泛使用。然而，过渡工具主要是 未经在艾滋病毒高流行地区进行测试，并且几乎没有系统的过渡方法 用于非洲。此外，有效的过渡只能在艾滋病毒披露的同时进行，而艾滋病毒披露可能会被推迟 由于看护者担心应对、内疚或无意中泄露机密。过渡性护理和 儿童艾滋病毒披露是艾滋病毒青少年的补充紧急优先事项。 我们建议调整 Got Transition 工具，以便在肯尼亚使用，我们之前观察到该国的过渡率较低。 青少年的保留和披露。我们将利用全国电子病历（KenyaEMR） 确定现有青少年治疗计划的成功过渡率，并确定预测因素 成功过渡（目标 1）。我们将采访青少年、看护者、医护人员和 政策制定者为肯尼亚使用的 Got Transition 工具的调整提供信息（目标 2）。最后，我们将测试一个 组合干预方案由经过调整的过渡工具加上先前验证的披露组成 整群随机试验中的工具（目标 3）。 该提案建立在华盛顿大学、 内罗毕大学和肯尼亚国家艾滋病/性传播感染控制计划 (NASCP)。我们的合作 NASCOP 使我们能够开展具有影响力、与当地相关且符合国家要求的研究 促进大规模实施的计划性方法。调整已建立的 Got Transition 模型 在肯尼亚使用并将其与披露工具包相结合是解决这一问题的有效方法 儿科到成人艾滋病毒护理之间的连续体，预计将产生一种新产品，可以 全国实施。该研究还将为可推广的结论提供重要证据 改善整个非洲艾滋病毒感染青少年的披露和过渡的方法。