Simulated Patient Encounters to Promote Early Detection and Engagement in HIV Care for Adolescents

 说明(申请人提供)：尽管在资源有限的情况下，艾滋病毒检测和治疗服务得到了极大的扩展，但青少年仍然受到艾滋病毒的不成比例的影响。2013年，联合国艾滋病规划署报告称，与任何其他年龄段相比，15至24岁的青少年艾滋病毒发病率最高。虽然成人和儿童人口的死亡率有所下降，但在过去7年中，青少年艾滋病毒相关死亡人数增加了50%。提供可获得和可接受的艾滋病毒检测、咨询和治疗服务不足被认为是青少年接受和保留艾滋病毒护理的障碍。此外，在我们小组的初步研究中，负责提供青少年艾滋病毒服务的卫生保健工作者经常报告说，他们感到准备不足，无法满足这一年龄段的需求。主要用于医学教育的模拟患者(SP)会诊作为一种机制，在资源不足的情况下为医护人员提供了一种改善关键决策、患者互动和沟通技能的机制，显示出巨大的潜力。这些接触不仅提供教学和指导，训练有素的演员和教师观察员可以为临床医生提供即时反馈和支持，而且还提供可以与临床结果进行比较的临床表现和能力的定量和定性衡量标准。我们假设，SP遇到的服务提供者将增加提供者的信心和能力，以促进艾滋病毒状况的披露，并提供与艾滋病毒感染青年的支持性互动，这反过来将增加青少年对艾滋病毒服务的接受和留存。我们建议开发和评估一种临床培训干预措施，利用标准化的患者行为者来改善卫生保健工作者在与青少年工作时的沟通和人际交往技能，从而提高对艾滋病毒护理的参与度。在目标1中，我们将针对肯尼亚青少年艾滋病毒相关的护理和咨询需求开发患者案例脚本，并建立达到能力所需的培训互动数量。目的2是一项整群随机对照阶梯楔形试验，评估SP遭遇对肯尼亚公共艾滋病毒治疗机构保留在护理中的青少年患者比例的影响。在目标3中，我们将确定SP干预的成本效益。这些数据将为肯尼亚和其他低资源环境的艾滋病毒项目提供有价值的信息，为改善青少年与关键艾滋病毒服务的联系和留住提供一个潜在的可扩展战略。

 DESCRIPTION (provided by applicant): Despite enormous expansion of HIV testing and treatment services in resource-limited settings, adolescents continue to be disproportionately affected by HIV. In 2013, UNAIDS reported that adolescents between the ages of 15-24 have the highest HIV incidence rates compared to any other age strata. And while mortality has decreased in adult and pediatric populations, there has been a 50% increase in adolescent HIV-related deaths over the last 7 years. Inadequate provision of accessible and acceptable HIV testing, counseling, and treatment services has been cited as a barrier to uptake of and retention in HIV care among adolescents. Additionally, in preliminary studies by our group, health care workers tasked with providing adolescent HIV services frequently reported feeling inadequately prepared to cope with the needs of this age group. Primarily used in medical education, simulated patient (SP) encounters show great promise as a mechanism for health care workers in low-resource settings to improve critical decision-making, patient interaction, and communication skills. These encounters serve not only to provide teaching and mentorship where a trained actor and a faculty observer can provide immediate feedback and support to the clinician, but also provide quantitative and qualitative measures of clinical performance and competency that can be compared to clinical outcomes. We hypothesize that SP encounters will increase provider confidence and capacity to facilitate HIV status disclosure and provide supportive interactions with HIV-infected youth, which will in turn increase uptake and improve retention in HIV services among adolescents. We propose to develop and evaluate a clinical training intervention utilizing standardized patient actors to improve communication and interpersonal skills of health care workers in working with adolescents, resulting in increased engagement in HIV care. In AIM 1, we will develop patient case scripts specific to adolescent HIV- related care and counseling needs in Kenya and establish the number of training interactions necessary to reach competency. AIM 2 is a cluster randomized controlled stepped-wedge trial assessing the impact of SP encounters on the proportion of adolescent patients retained in care at public HIV treatment facilities in Kenya. In AIM 3 we will determine the cost effectiveness of the SP intervention. These data will contribute valuable information to HIV programs in Kenya and other low-resource settings, providing a potentially scalable strategy to improve adolescent linkage to and retention in critical HIV services.