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

• 批准号: 10704639
• 负责人: Molly Forrest Franke
• 金额: $ 65.01万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704639
• 关键词: Acute; Address; Adherence; Adolescence; Adolescent; Adoption; Adult; Advocate; Age; Appointment; Behavioral; Brain; Caregivers; Caring; Childhood; Chronic; Clinic; Communities; Community Health; Compensation; Complex; Continuity of Patient Care; Coping Skills; Data; Development; Diagnosis; Disclosure; Disease Management; Disparity; Distress; Education; Effectiveness; Effectiveness of Interventions; Emotional; Ensure; Environment; 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; 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; 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; cohort; cost; cost effectiveness; cost estimate; early experience; early life adversity; economic evaluation; experience; housing instability; implementation evaluation; implementation intervention; improved; medication compliance; multidisciplinary; peer; peer influence; peer networks; perceived stress; post intervention; programs; psychosocial; randomized trial; randomized, clinical trials; screening; secondary endpoint; sexual debut; skills; social stigma; therapy design; transmission process; uptake

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 在青少年艾滋病毒护理中，从儿科向成人护理的过渡是一个特别不稳定的时期。然而，几乎没有 知道哪些干预措施可能最有效地支持青少年度过这一时期。我们 将建立在我们完善的社区健康平台和现有的青少年干预研究基础上 居住在秘鲁利马，提供有关有效、成本和实施前景看好的 以社区为基础的差异化护理干预，支持青少年过渡到成人艾滋病毒护理。 我们最近在秘鲁对30名不同的青少年进行了初步研究，这在拉丁美洲是第一次， 显示出广泛的可接受性和令人信服的证据，证明了关于#年成果的有效性 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，以克服行政管理 护理障碍(例如，保险变更、医疗中心转移)；成人预约的伴随 诊所；社会支助小组；教育和技能培养会议；以及心理健康筛查和转介。 支持的强度和干预的持续时间(6个月或12个月)将根据 患者层面的因素，如依从性、病毒载量抑制、家庭支持的存在和过渡 准备好了。 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) 与病毒载量抑制的滞留和其他良好的指标干预的有效性 是存在的。我们将比较12个月和24个月不成功过渡的累积发生率，并分层 通过差别化护理途径得出的结果(即接受干预的强度)。我们将估计 研究干预的成本和成本效益，即每增加一次成功过渡的成本 已实现。此外，我们还将提供有关实施考虑因素的数据，这些考虑因素对于吸收、可持续和 成功地被公共部门采用。这些问题包括干预的范围和有效性以及 短期和长期内每个干预组成部分的相对重要性。在追求这些目标时，我们将 解决在对青少年艾滋病毒携带者进行干预方面存在的严重信息差距 美国的背景。