Understanding the role of schools in supporting HIV treatment outcomes among HIV infected adolescents

项目摘要/摘要 拟议的K43新兴全球领导者奖(非临床试验要求)的总体目标是 支持恩朱古纳博士的研究培训，以发展在艾滋病毒研究方面的独立事业。恩朱古纳博士是一名 肯尼亚内罗毕肯雅塔国家医院的研究科学家。这项拟议的工作审查了独特的 在青少年艾滋病毒的背景下，教育和卫生之间的交叉。恩朱古纳博士的培训目标是 获得干预开发的以人为中心的设计方面的专业知识，实施科学(IS)，混合 方法和青少年研究。这项工作还将提供与政策制定者密切合作的机会， 并将她之前获得的临床流行病学技能与现实世界的方法联系起来。这项建议 利用由导师和合作者组成的多学科团队，他们最终将支持恩朱古纳博士的目标 成为青少年艾滋病毒研究中富有成效和影响力的独立调查者。 该方案的研究目标是通过使用混合方法来使用以人为中心的设计方法 研究以深入了解学校环境及其对实现治疗的贡献 目标，并协作和迭代地开发以学校为基础的干预措施，以改善 艾滋病毒携带者(ALWHIV)在校青少年。有越来越多的ALWHIV患者存活到 成人期。这些儿童需要支持，以维持青春期和跨学校的药物使用 人生转折。关于以学校为基础的干预措施支持治疗的证据有限，尽管事实是 大多数艾滋病人都在学校就读(包括寄宿学校)。这项建议的目的是：1. 评估可用于ALWHIV的现有学校结构以及照顾者和ALWHIV的关键决定因素 选择学校的决定，2.确定与学校有关的病毒抑制和护理保留的相关性，3.到 在选定的非健康学校开展和试行学校教职员工培训和同伴支持干预 结果(可接受性、可行性和适当性)。 据我们所知，这是第一次提出定量描述与学校有关的 撒哈拉以南非洲(SSA)的临床结果，并评估影响ALWHIV择校的因素。这个 这项研究汇集了来自肯尼亚国家教育和卫生部门的不同利益相关者团队 并利用多步骤方法来实现研究目标。这种方法将允许进行严格的干预 开发流程，并为在未来的R01中进行强有力的协作工作铺平道路，以测试 以学校为基础的一揽子干预措施，以改善结果，包括病毒抑制，在学校学习的ALWHIV， 这可能会使患有其他非艾滋病毒慢性病的青少年受益。恩朱古纳博士的研究目标 与她的培训目标相一致，在完成这个奖项后，她将处于一个极好的地位 提交R01申请，以进一步推进ALWHIV研究。

PROJECT SUMMARY/ABSTRACT The overall goal of the proposed K43 Emerging Global Leader Award (non-clinical trials requirement) is to support Dr. Njuguna’s research training to develop an independent career in HIV research. Dr. Njuguna is a research scientist at the Kenyatta National Hospital, Nairobi, Kenya. The proposed work examines the unique intersection between education and health in the context of adolescent HIV. Dr. Njuguna’s training goals are to gain expertise in human centered design for intervention development, implementation science (IS), mixed methods and adolescent research. This work will also provide an opportunity to work closely with policy makers, and link clinical epidemiology skills she has previously acquired with real world IS methods. The proposal leverages a multidisciplinary team of mentors and collaborators who will ultimately support Dr. Njuguna’s goal to become a productive and influential independent investigator in adolescent HIV research. The research goal of this proposal is to use a human centered design approach by utilizing mixed methods research to gain an in-depth understanding of the school environment and its contribution to achieving treatment goals, and to collaboratively and iteratively develop a school-based intervention to improve outcomes among school-going adolescents living with HIV (ALWHIV). There is a growing population of ALWHIV surviving to adulthood. These children need support to sustain medication use during adolescence and across school and life transitions. There is limited evidence on school-based interventions to support treatment, despite the fact that most ALWHIV are enrolled in school (including boarding schools). The Aims of this proposal are: 1.To evaluate existing school-based structures available for ALWHIV and key determinants of caregiver and ALWHIV school choice decisions, 2.To determine school-related correlates of viral suppression and retention in care, 3.To develop and pilot a school staff training and peer support intervention in selected schools for non-health outcomes (acceptability, feasibility and appropriateness). This is the first study to our knowledge to propose to quantitatively characterize school-related correlates of clinical outcomes in sub-Sahara Africa (SSA) and evaluate factors influencing school choice for ALWHIV. The study brings together a diverse team of stakeholders from the Kenyan national Education and Health sectors and utilizes a multi-step approach to achieve study objectives. This approach will allow for rigorous intervention development process, and pave way for a strong collaborative effort in a future R01 to test effectiveness of a school-based intervention package to improve outcomes, including viral suppression, in school-going ALWHIV, that could potentially benefit adolescents with other non-HIV chronic illnesses. Dr. Njuguna’s research goals correspond with her training goals, and at the completion of this award, she will be in an excellent position to submit an R01 application to further advance research in ALWHIV.