Implementation Research to Optimize ART Delivery for Adolescent Girls and Young Women Living with HIV in Tanzania

优化坦桑尼亚艾滋病毒感染青春期女孩和年轻女性抗逆转录病毒治疗的实施研究

• 批准号: 10547999
• 负责人: Katherine B Rucinski
• 金额: $ 15.97万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10547999
• 关键词: Active Learning; Address; Adolescence; Adolescent; Adolescent Development; Adolescent Health Services; Adolescent and Young Adult; Adopted; Africa South of the Sahara; Age; Award; Caring; Characteristics; Clinic; Communities; Consolidated Framework for Implementation Research; Data; Development; Diagnosis; Eastern Africa; Economics; Educational workshop; Effectiveness; Effectiveness of Interventions; Emotional; Ensure; Evidence based intervention; Female Adolescents; Focus Groups; Foundations; Funding; Goals; Government; HIV; HIV Infections; Health; Health care facility; Hour; Hybrids; Incidence; Infection; Institutional Practice; Interdisciplinary Study; Intervention; Interview; Investments; Link; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; Partnership Practice; Patients; Pattern; Personal Satisfaction; Physiological; Population; Positioning Attribute; Poverty; Prevention; Prevention program; Process; Provider; Psychiatric Social Work; Qualitative Research; Randomized; Recommendation; Reproductive Health Services; Research; Research Methodology; Research Personnel; Research Project Grants; Resource-limited setting; Risk; Services; Sexual Health; Social Behavior; Southern Africa; Structure; Surveys; System; Tanzania; Teenagers; Testing; Time; Training; Training Programs; Viral; Woman; adolescent health; aged; antiretroviral therapy; career; effectiveness trial; emerging adult; girls; health care delivery; high risk; implementation research; implementation science; implementation strategy; improved; innovation; lens; meetings; mortality; multidisciplinary; peer; peer support; programs; response; scale up; skills; social exclusion; social stigma; social structure; theories; therapy adherence; tool; transmission process; uptake; young woman

PROJECT SUMMARY This five-year K01 Mentored Research Scientist Development Award will provide Dr. Rucinski with the mentorship and training to become an independent investigator focused on research that optimizes the health and well-being of women and girls at high risk of HIV acquisition and transmission in sub-Saharan Africa. Training is at the foundation of this proposal and comprises mentorship with expert and multi-disciplinary implementation science (IS) researchers, didactic coursework, experiential learning, meetings with key HIV and stakeholders and community leaders, and rigorous mentored research. The following training objectives will be accomplished during this award: (1) Obtain scientific expertise in the concepts, theories, tools and methods used to advance HIV-related IS research and practice; (2) Develop comprehensive skills in qualitative research methods to support the application of mixed-methods approaches for HIV-related IS research; and (3) Acquire content expertise in adolescent health and development to inform the tailoring, adaptation, and testing of developmentally appropriate sexual and reproductive health services for adolescents and young adults. Supported by these objectives, the proposed mentored research project will generate a tailored packaged of implementation strategies to strengthen contextually appropriate antiretroviral therapy (ART) programs for adolescent girls and young women (AGYW) aged 15-24 living with HIV in Dar es Salaam. In Tanzania, a quarter of all new annual HIV infections are among AGYW. Despite efforts to decrease incident infections, the number of AGYW living with HIV in southern and eastern Africa continues to rise and increasingly, the burden is among those with sexually acquired HIV . Further, more than half of the 130,000 AGYW living with HIV in Tanzania are virally unsuppressed, increasing their risk for onward HIV transmission, morbidity, and mortality. Few evidence- based interventions exist to improve retention in care and viral suppression for adolescents, and even fewer have been implemented at scale. Peer support models known as “teen clubs” have been prioritized by PEPFAR and the Government of Tanzania for scale up. Yet evidence to support the feasibility, acceptability, and effectiveness of this intervention is mixed, and implementation research is needed to close the evidence to practice gap. Guided by a community-driven implementation planning framework and the Consolidated Framework for Implementation Research (CFIR), we propose the following aims in Dar es Salaam: (1) Examine the social, structural, and clinic-level factors associated with retention in care and HIV viral suppression among AGYW participating in the DREAMS prevention program who were newly infected or diagnosed with HIV; (2) Refine a tailored package of implementation strategies to optimize a peer-support model for HIV treatment; and (3) Pilot the feasibility, acceptability, and preliminary effectiveness of a tailored package of implementation strategies for AGYW living with HIV. Findings will form the foundation for a R01-level randomized hybrid effectiveness trial and will facilitate Dr. Rucinski’s transition to independence.

项目摘要 这个为期五年的K 01指导研究科学家发展奖将为Rucinski博士提供 指导和培训，成为一个独立的调查员，专注于研究，优化健康 在撒哈拉以南非洲，艾滋病毒感染和传播风险高的妇女和女孩的健康和福祉。培训 是这项建议的基础，包括与专家和多学科的指导， 实施科学（IS）研究人员，教学课程，体验式学习，会议与关键 艾滋病毒和 利益相关者和社区领袖，以及严格的指导研究。培训目标如下： 在此奖项期间完成：（1）获得所用概念，理论，工具和方法的科学专业知识 促进艾滋病相关的信息系统研究和实践;（2）发展定性研究的综合技能 支持混合方法在艾滋病毒相关信息系统研究中应用的方法;（3）获得 青少年健康和发展方面的内容专业知识，为定制，适应和测试提供信息， 为青少年和年轻人提供适合其发展的性健康和生殖健康服务。 在这些目标的支持下，拟议的导师制研究项目 将产生一个定制的包装， 实施战略，以加强适合具体情况的抗逆转录病毒疗法方案， 达累斯萨拉姆15-24岁感染艾滋病毒的少女和年轻妇女。在坦桑尼亚， 每年新感染艾滋病毒的人中有一半是青少年。尽管努力减少感染事件， 南部和东部非洲感染艾滋病毒的青年男女的比例继续上升，负担越来越重， 性行为感染艾滋病毒者 .此外，在坦桑尼亚13万名艾滋病毒感染者中， 病毒未被抑制，增加了他们进一步传播艾滋病毒、发病和死亡的风险。几乎没有证据- 现有的干预措施可以改善青少年的护理保留和病毒抑制， 已经大规模实施。被称为“青少年俱乐部”的同伴支助模式已被总统艾滋病紧急救援计划列为优先事项 和坦桑尼亚政府进行推广。然而，有证据表明， 这种干预措施的效果好坏参半，需要进行实施研究，以接近证据， 实践差距以社区驱动的实施规划框架和《综合行动计划》为指导， 实施研究框架（CFIR），我们提出在达累斯萨拉姆的以下目标：（1） 研究与继续护理和HIV病毒感染相关的社会、结构和临床因素。 参与DREAMS预防计划的AGYW中的抑制，这些人是新感染的， （2）完善一套有针对性的实施战略，以优化同伴支持模式 艾滋病毒治疗;（3）试点的可行性，可接受性和初步有效性的定制包 艾滋病毒感染者青年女青年的执行战略。调查结果将构成R 01级的基础 随机混合有效性试验，并将促进鲁辛斯基博士的过渡到独立。