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

项目摘要 在青少年艾滋病毒护理中，从儿科护理向成人护理的过渡是一个非常不稳定的时期。然而， 我们知道哪些干预措施可能是最有效的支持青少年通过这一时期。我们 将建立在我们完善的社区卫生平台和现有的青少年干预研究基础上 生活在利马，秘鲁，提供关键数据的有效性，成本和实施一个有前途的 以社区为基础的差别化护理干预措施，支持青少年向成人艾滋病毒护理过渡。 我们最近在秘鲁的30名青少年中进行了一项试点研究，这是拉丁美洲的第一项此类研究， 证明了广泛的可接受性和令人信服的有效性证据， 坚持，社会支持，自我效能和过渡准备。干预措施包括稳定 紧急需求（例如，住房不稳定或无家可归）;卫生系统导航，以克服行政 护理障碍（即，保险变化，健康中心转移）;成人预约陪同 诊所;社会支助小组;教育和技能建设课程;以及心理健康筛查和转诊。 支持的强度和干预的持续时间（6个月或12个月）将根据以下因素区分： 患者水平的因素，如依从性、病毒载量抑制、家庭支持的存在和过渡 准备就绪。 我们将进行一项双臂随机临床试验，以确定短期和长期（即，干预后） 干预措施在病毒载量抑制的保留方面的有效性以及其他良好的指标， 存在我们将比较12个月和24个月时过渡不成功的累积发生率，并分层 差异化护理途径的发现（即，干预的强度）。我们将估计 研究干预的成本和成本效益，即每次额外成功过渡的成本 办妥了一批此外，我们还将提供有关实施考虑因素的数据，这些考虑因素对吸收、可持续性和 公共部门的成功采用。其中包括干预的范围和有效性， 每个干预部分在短期和长期的相对重要性。为了实现这些目标，我们将 解决拉丁美洲和加勒比艾滋病毒感染青少年干预措施方面的严重信息差距， 美国背景。

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.