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

 描述（由申请人提供）：尽管艾滋病毒检测和治疗服务在资源有限的环境中得到了极大的扩展，但青少年仍然不成比例地受到艾滋病毒的影响。2013年，联合国艾滋病规划署报告说，与其他任何年龄段相比，15至24岁的青少年的艾滋病毒感染率最高。虽然成人和儿童的死亡率有所下降，但在过去7年中，青少年艾滋病毒相关死亡人数增加了50%。缺乏可获得和可接受的艾滋病毒检测、咨询和治疗服务被认为是青少年接受和保持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，他们感到没有做好充分准备，无法科普这一年龄组的需求。在医学教育中使用的优先级，模拟病人（SP）的遭遇显示出巨大的希望，作为一种机制，为卫生保健工作者在低资源的设置，以提高关键的决策，病人的互动和沟通技巧。这些接触不仅可以提供教学和指导，让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，而且还可以提供临床表现和能力的定量和定性测量，可与临床结果进行比较。我们假设，SP的遭遇将增加供应商的信心和能力，以促进艾滋病毒状态披露，并提供支持性的互动与艾滋病毒感染的青年，这反过来又会增加吸收和改善青少年中的艾滋病毒服务的保留。我们建议开发和评估临床培训干预措施，利用标准化的病人演员，以提高沟通和人际交往能力的卫生保健工作者在与青少年的工作，从而增加参与艾滋病毒护理。在目标1中，我们将制定针对肯尼亚青少年艾滋病毒相关护理和咨询需求的患者案例脚本，并建立达到能力所需的培训互动数量。AIM 2是一项整群随机对照阶梯楔形试验，评估SP接触对肯尼亚公共艾滋病毒治疗机构青少年患者比例的影响。在AIM 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方案提供宝贵的信息，提供一个潜在的可扩展战略，以改善青少年与关键艾滋病毒服务的联系和保留。

 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.