权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Efficacy of a differentiated care intervention for adolescents transitioning to adult HIV care in Peru

秘鲁青少年向成人艾滋病毒护理过渡的差异化护理干预措施的效果

基本信息

批准号：
10546049
负责人：
Molly Forrest Franke
金额：
$ 80.29万
依托单位：
HARVARD MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10546049
关键词：
Acute Address Adherence Adolescence Adolescent Adoption Adult Advocate Age Appointment Behavioral Brain Caregivers Caring Childhood Chronic Clinic Communities Community Health Complex Continuity of Patient Care Coping Skills Data Development Diagnosis Disclosure Disease Management Distress Education Effectiveness Effectiveness of Interventions Emotional Ensure Face HIV HIV-infected adolescents Health Health Personnel Health Services Health system Healthcare Homelessness Incidence Informal Social Control Insurance Intervention Intervention Studies Intervention Trial Latin America Latin American Life Logistics Medical Mental Health Morbidity - disease rate Neurocognitive Outcome Pathway interactions Patient Care Patients Personal Satisfaction Peru Pilot Projects Prefrontal Cortex Pregnancy Provider Psychosocial Assessment and Care Puberty Public Sector Qualitative Methods Randomized Clinical Trials Readiness Rewards Risk Risk-Taking Self Efficacy Social isolation Social support Substance Use Disorder Support Groups Testing Time Training Trauma Treatment Efficacy Viral Load result age group arm barrier to care base cohort cost cost effectiveness cost estimate early experience early life adversity economic evaluation experience housing instability implementation cost implementation evaluation implementation intervention improved medication compliance multidisciplinary peer peer influence peer networks perceived stress post intervention programs psychosocial randomized trial screening secondary endpoint sexual debut skills social stigma supportive environment therapy design transmission process uptake

项目摘要

PROJECT SUMMARY The transition from pediatric to adult care is an exceptionally precarious time in adolescent HIV care. Yet, little is known about which interventions might be most effective in supporting adolescents through this period. We will build on our well-established community-health platform and existing intervention research with adolescents living in Lima, Peru, to provide critical data on the effectiveness, cost, and implementation of a promising community-based differentiated care intervention that supports adolescents as they transition to adult HIV care. Our recent pilot study among a diverse group of 30 adolescents in Peru, the first of its kind in Latin America, demonstrated broadscale acceptability and convincing evidence of effectiveness with regard to outcomes of adherence, social support, self-efficacy and transition readiness. The intervention consists of stabilization of acute needs (e.g., housing instability or homelessness); health systems navigation to overcome administrative barriers to care (i.e., insurance changes, health center transfers); accompaniment to appointments in the adult clinic; social support groups; education and skills-building sessions; and mental health screening and referrals. The intensity of support and duration of the intervention (6 months or 12 months) will be differentiated based on patient-level factors such as adherence, viral load suppression, presence of familial support, and transition readiness. We will conduct a two-arm randomized clinical trial to determine the short- and long-term (i.e., post-intervention) efficacy of the intervention with regard to retention with viral load suppression as well as other indicators of well- being. We will compare the cumulative incidence of unsuccessful transition at 12- and 24-months, and stratify findings by the differentiated care pathway (i.e., the intensity of the intervention received). We will estimate the cost and cost-effectiveness of the study intervention in terms of cost per additional successful transition achieved. And, we will provide data on implementation considerations essential for uptake, sustainability, and successful adoption by the public sector. These include the reach of the intervention and the effectiveness and relative importance of each intervention component over the short and long-term. In pursuing these aims we will address a critical disparity of information with regard to interventions for adolescents living with HIV in the Latin American context.

项目总结