Evaluating a Youth focused economic empowerment approach to HIVTreatment

描述(由申请人提供)：拟议的研究审查了一项创新干预措施的影响和成本，以提高艾滋病毒感染(HIV)青少年对艾滋病毒治疗的依从性(以下简称Suubi依从性)。Suubi坚持是由一种有效的经济赋权干预措施提供信息的，该干预之前在乌干达Suubi的艾滋病孤儿身上进行了测试，并借鉴了资产理论和以前的坚持研究。加入Suubi的目的是：1)为贫穷的艾滋病毒青少年及其家庭促进创收活动--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病管理有关的具体财务需求；2)为坚持抗逆转录病毒疗法(ART)提供支持。来自乌干达和撒哈拉以南非洲大部分地区(SSA)的研究表明，受艾滋病毒影响不成比例的一个群体是经济脆弱的儿童。对于这些人来说，坚持治疗方案可能需要达到许多年轻人没有经历过的经济稳定水平。事实上，经常提到的不遵守的原因是经济上的，例如缺乏药物、看诊所的交通工具以及食物和营养补充剂的资源。贫困儿童不太可能坚持抗逆转录病毒治疗和其他与健康相关的养生法。然而，到目前为止，没有一项遵守干预措施侧重于根本的经济驱动因素，这可能有助于解释为什么对贫困的艾滋病毒青少年进行遵守干预的结果充其量只能产生轻微到中等的影响。这项拟议的研究将随机将乌干达南部受艾滋病毒/艾滋病严重影响的地区Rakai、Masaka和Lwengo地区的32家医疗诊所护理的736名艾滋病毒青少年(研究开始时年龄在12岁至15岁之间)随机分配到两种研究条件之一：Suubi依从性与强化护理标准(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依从性干预措施对艾滋病毒青少年遵守艾滋病毒治疗方案的关键结果的影响，包括：参与者获得和补充处方药物并遵守处方每日用药程序的能力：a)不跳过剂量，b)在正确的时间服用，c)参与者的健康知识和健康行为(例如，遵守医疗预约，遵循营养建议)，d)CD4，和HIV相关的生物标记物(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、未来计划和抱负、自我效能感)；以及3)检查与Suubi坚持相关的成本。这项研究将促进知识，并为旨在提高诸如SSA等低资源地区艾滋病毒青少年坚持艾滋病毒治疗的方案的制定提供信息。这项研究将为经济赋权计划对短期和长期影响的影响提供关键证据。

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.