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

以数据为依据的分级护理 (DiSC) 可改善青少年艾滋病毒治疗结果

• 批准号: 10227279
• 负责人: Grace John-Stewart
• 金额: $ 93.48万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227279
• 关键词: Acceleration; Adherence; Adolescent; Adopted; Adult; Age; Alcohol or Other Drugs use; Anti-Retroviral Agents; Behavioral; Caregiver support; Caregivers; Caring; Childhood; Client; Client satisfaction; Clinic; Clinical; Cluster randomized trial; Committee Members; Communities; Computerized Medical Record; Consent; Continuity of Patient Care; Data; Decision Making; Development; Educational workshop; Effectiveness; Enrollment; Ethics; Ethics Committees; Failure; Family; Focus Groups; Frequencies; Group Interviews; HIV; HIV Seropositivity; HIV-infected adolescents; Health Personnel; Health Promotion; Health Services; Health Services Research; High Prevalence; Intensive Care; Intervention; Kenya; Lawyers; Medical Records; Mental Health Services; Modeling; Outcome; Patients; Pharmacy facility; Policies; Policy Maker; Population; Prospective cohort; Public Health; Records; Research; Resources; Risk; Services; Standardization; Student Dropouts; Surveys; Treatment Protocols; Treatment outcome; Viral; Visit; Wait Time; Work; Workload; Youth; age group; base; care outcomes; cofactor; cohort; effectiveness evaluation; experience; follow-up; high risk; improved; improved outcome; innovation; multidisciplinary; peer support; primary outcome; programs; recruit; secondary outcome; social; standard of care; therapy development; tool; treatment as usual; virology

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.

项目概要/摘要 青少年（10-19 岁）的保留率、抗逆转录病毒 (ART) 依从性和病毒感染率均偏低 与其他年龄组相比受到抑制。高流行率、资源有限环境中的艾滋病毒护理计划 开发了创新方法来改善连接、保留和病毒抑制，包括简化 治疗方案、任务转移和同伴支持。然而，明确的招生政策和做法 青少年参与艾滋病毒服务和研究，以及确定需要哪些青少年的系统战略 缺乏更多的重症监护来成功实现艾滋病毒护理连续性的关键里程碑。 '阶梯式 护理”方法，其中风险最高的客户接受越来越高强度和频率的护理， 已被用于有针对性的干预和有效利用资源。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遭受负面影响的风险更大的青少年 结果以及对它们的直接干预支持。我们的基于数据的分级护理 (DiSC) 干预对 使用临床预测工具进行分级护理，以优化有限的资源并改善艾滋病毒护理和治疗 结果。我们的团队在肯尼亚的儿科和成人艾滋病毒项目中工作了二十多年， 包括已建立的青少年艾滋病毒研究库，建议实施这种组合数据- 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并改善青少年 肯尼亚的艾滋病毒护理。 UG3 的形成工作将包括建立一个基于临床的前景队列 肯尼亚西部 6 个大量艾滋病毒诊所的 10-19 岁青少年及其护理人员。基于数据 通过对电子病历的调查和提取，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来识别需要更多治疗的青少年 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 以及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，将为青少年艾滋病毒 DiSC 干预措施的开发和优化提供信息 UH3 的治疗管理。 DiSC 将通过一项针对 20 名高容量 HIV 患者的整群随机试验进行评估 诊所，关注有效性（6 个月和 12 个月的保留、病毒抑制、ART 依从性）和 实施结果（可行性和可接受性）。这些目标有可能提供一个可推广的、 提供与不同艾滋病毒护理计划相结合的差异化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。