The Adolescent to Adult Patient-centered HIV Transition Study (ADAPT)

新出现的成年艾滋病毒感染者面临的一个独特挑战是，他们的护理从长期的 长期儿科艾滋病毒提供者在成人艾滋病毒项目治疗。虽然从概念上说， 儿科到成人护理似乎很简单，但现实是，过渡往往是一个非常困难的过程。 过程转型不成功的后果可能是困难的，也可能是灾难性的。的 以青少年为中心的艾滋病病毒向成年人转变（ADAPT）研究是一项创新的随机试验， 针对护理差距的干预措施，这些差距是抗逆转录病毒治疗连续护理级联中损失的主要驱动因素， 儿童和青少年面临的问题是，越来越多的青少年错过了让青少年参与护理的机会。的具体目标 适应行动的主要目的是：（a）为资源有限环境下的过渡服务战略提供信息;（B）审查 预测成功过渡的发展、临床和其他因素;以及（c）获得基本的 通过自我网络的应用深入了解非洲青少年中的实施障碍 明确的社会支持，为结构化干预的目标提供信息。我们的多PI团队包括强大的 在儿科和青少年艾滋病护理、流行病学和社会科学方面的互补专业知识。ADAPT将 在中部、南部和北方尼日利亚的选定地点进行， 人类病毒学，尼日利亚。为了实现目标1，我们将进行六个重点小组，包括：青少年患者， 父母和医护人员。为了实现目标2，我们将进行一项随机分组临床试验。的 两项干预措施是基于先前的循证参与战略：1）教育干预措施 和2）干预措施，使用同伴过渡倡导者谁准备青少年和他们的父母， 过渡我们将入组300例患者（每组150例患者）。研究中心将随机分配至 干预主要成果将是成功过渡，在一年内保持两次后续预约， 过渡期后的9个月。焦点小组参与者建议的次要结局 也将被衡量。研究社交网络组件的潜在作用以及两者的特征 自我和改变的主要结果，广义估计方程（GEE）的方法将用于 探索主要结果与自我、改变和网络层面因素之间的关联。的 这项研究的结果将指导尼日利亚和其他国家的过渡期青少年的最佳做法。 这些国家是具有类似挑战和潜在重大影响的中低收入国家。

One of the distinct challenges faced by emerging adults with HIV is the transition of their care from their long- term pediatric HIV provider to treatment within an adult HIV program. While conceptually the transition from pediatric to adult care may seem straightforward, the reality is that the transition often is a very difficult process. The consequences of an unsuccessful transition can range from difficult to catastrophic. The Adolescent to Adult Patient-centered HIV Transition (ADAPT) Study is a randomized trial of innovative interventions targeting gaps in care that are major drivers of loss in the ART continuum of care cascade among adolescents and increasing missed opportunities to engage adolescents into care. The specific aims of ADAPT are: (a) to inform strategies for transition services in resource-limited settings; (b) to examine the developmental, clinical, and other factors that predict a successful transition; and (c) to gain fundamental insight on implementation barriers among African adolescents through the application of the ego-network defined social support that will inform targets for structured intervention. Our multi-PI team includes strong complementary expertise in pediatric and adolescent HIV care, epidemiology, and social science. ADAPT will be conducted in central, southern, and northern Nigeria at selected PEPFAR sites supported by the Institute of Human Virology, Nigeria. To address Aim 1 we will conduct six focus groups including: Adolescent patients, parents and health care providers. To address aim 2, we will conduct a cluster randomized clinical trial. The two interventions are based on prior evidence-informed engagement strategies: 1) educational interventions and 2) interventions that use a peer transition advocate who prepares the adolescent and their parents for transition. We will enroll 300 patients (150 patients in each arm). The sites will be randomized to an intervention. The primary outcome will be successful transition, keeping two follow-up appointments within a nine months period following transition. Secondary outcomes, as recommended by focus group participants will also be measured. To examine the potential role of social network components and characteristics of both egos and alters on primary outcomes, a Generalized Estimating Equation (GEE) approach will be used to explore the associations between primary outcomes and factors at the ego, alter, and network levels. The finding from this study will guide institution of best practices for transitioning adolescents in Nigeria and other countries lower and middle income countries with similar challenges and potential for high impact.