Data-informed Stepped Care (DiSC) to Improve Adolescent HIV Outcomes

项目总结/摘要 青少年（10-19岁）的保留率、抗逆转录病毒（ART）坚持率和病毒感染率都不成比例地低。 与其他年龄组相比，在高流行率、资源有限的环境中开展艾滋病毒护理方案 已经开发出创新的方法来改善链接，保留和病毒抑制，包括简化的 治疗方案、任务转移和同伴支持。然而，明确的入学政策和做法 艾滋病毒服务和研究中的青少年，以及系统的战略， 在艾滋病毒护理的连续性过程中，缺乏更多的强化护理，以成功实现沿着的关键里程碑。“踏步 “护理”方法，其中风险最大的客户得到越来越多的护理强度和频率， 已被用于有针对性的干预措施和有效利用资源。使用标准化的临床预测工具 风险评分可以帮助医疗保健提供者识别青少年在经历负面的风险更大， 结果和直接干预支持他们。我们基于数据的阶梯式护理（DiSC）干预对 利用临床预测工具进行分级护理，以优化有限的资源，改善艾滋病毒护理和治疗 成果。我们的团队在肯尼亚从事儿童和成人艾滋病毒项目已经超过20年， 包括青少年艾滋病毒研究的既定剧目，建议实施这一组合数据- 使用阶梯式护理模式进行驱动干预，为公共卫生决策提供信息， 肯尼亚的艾滋病护理。UG 3的形成性工作将包括建立一个基于临床的前景队列， 在肯尼亚西部，10-19岁的青少年及其护理人员在6个高容量艾滋病毒诊所工作。基于数据 从电子医疗记录的调查和抽象中得出，我们将确定损失的关键预测因素， 护理和疑似病毒学失败，并开发临床预测工具，以确定青少年需要更多的 大力支持。我们将进行焦点小组和访谈，以了解和优化青少年的同意 和代表参与艾滋病毒护理和研究。这项工作，包括青少年和社区 利益相关者的观点，将为DiSC青少年艾滋病毒干预措施的制定和优化提供信息 在UH 3的治疗管理。DiSC将通过一项随机分组试验在20个高容量HIV感染者中进行评估。 诊所，观察有效性（6个月和12个月的保留，病毒抑制，ART依从性）和 执行结果（可行性和可接受性）。这些目标有可能提供一个可推广的， 提供与各种艾滋病毒护理计划相结合的有区别的青少年艾滋病毒护理的系统方法 以及可用的支持选项，以加快实现青少年90-90-90目标的进展。

PROJECT SUMMARY/ABSTRACT Adolescents (ages 10-19) experience disproportionately low retention, antiretroviral (ART) adherence and viral suppression compared to other age groups. HIV care programs in high prevalence, resource-limited settings have developed innovative approaches to improve linkage, retention and viral suppression, including simplified treatment regimens, task-shifting, and peer support. However, clear policies and practices for enrolling adolescents in HIV services and research, as well as systematic strategies that identify adolescents who need more intensive care to successfully achieve key milestones along the HIV care continuum, are lacking. ‘Stepped care’ approaches, where the most at-risk clients receive increasing levels of intensity and frequency of care, have been used to target interventions and efficiently use resources. A clinical prediction tool using standardized risk scores can help healthcare providers to identify adolescents at greater risk of experiencing negative outcomes and direct interventional support to them. Our data-informed stepped care (DiSC) intervention pairs stepped care with a clinical prediction tool to optimize limited resources and improve HIV care and treatment outcomes. Our team, which has worked with pediatric and adult HIV programs in Kenya for over two decades, including an established repertoire of adolescent HIV studies, proposes to implement this combination data- driven intervention using a stepped care model to inform public health decision-making and improve adolescent HIV care in Kenya. Formative work in UG3 will include establishment of a clinic-based prospect cohort of adolescents ages 10-19 and their care givers at 6 high volume HIV clinics in Western Kenya. Based on data derived from surveys and abstraction of electronic medical records, we will determine key predictors of loss to care and suspected virologic failure, and develop a clinical prediction tool to identify adolescents needing more intensive support. We will conduct focus groups and interviews to understand and optimize adolescent consent and representative participation in HIV care and research. This work, including adolescent and community stakeholder perspectives, will inform development and optimization of the DiSC intervention for adolescent HIV treatment management in UH3. DiSC will be evaluated through a cluster randomized trial at 20 high-volume HIV clinics, looking at both effectiveness (6 and 12-month retention, viral suppression, ART adherence) and implementation outcomes (feasibility and acceptability). These aims have potential to provide a generalizable, systematic approach to deliver differentiated adolescent HIV care that integrates with diverse HIV care programs and available support options to accelerate progress toward achieving the 90-90-90 targets for adolescents.