Bridges2Scale: Testing implementation strategies for an intervention among young people affected by AIDS

Bridges2Scale：测试对受艾滋病影响的年轻人进行干预的实施策略

• 批准号: 10713990
• 负责人: Noeline Nakasujja
• 金额: $ 67.54万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10713990
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescent; Affect; Africa South of the Sahara; Age; Behavior; Businesses; Caring; Clinical effectiveness; Communities; Contracts; Development; Economics; Education; Educational Status; Effectiveness; Ensure; Evidence based practice; Family; Foundations; Funding; Future; Government; HIV; HIV Seronegativity; Health; Household; Hybrids; Incentives; Income; Intervention; Interview; Investments; Kenya; Maps; Mental Health; Mentorship; Methods; Modification; Outcome; Outcome Measure; Participant; Penetration; Perception; Persons; Preparation; Prevalence; Process; Protocols documentation; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research; Research Priority; Resource-limited setting; Risk; Risk Taking; Savings; Schools; Signal Transduction; Site; Structure; Students; System; Testing; Training; Uganda; Underserved Population; United States National Institutes of Health; Viral; Youth; arm; cohesion; comparative cost effectiveness; cost; cost comparison; cost effectiveness; design; economic evaluation; effectiveness evaluation; empowerment; experience; financial literacy; implementation determinants; implementation outcomes; implementation process; implementation strategy; implementation/effectiveness; improved; meetings; member; post intervention; pre-exposure prophylaxis; primary outcome; psychosocial; public-private partnership; randomized, clinical trials; recruit; scale up; sexual risk taking; standardize measure; theories; transmission process; treatment adherence

PROJECT ABSTRACT Sub-Saharan Africa (SSA), a region dominated by low-resource communities and relatively poor families, is experiencing rising HIV prevalence among adolescents and youth (AY). Household economic hardships heighten the risk for AY’s engaging in health-compromising behaviors and their poor engagement with care. This increases their risk for contracting and transmitting HIV and non-adherence to ART treatment. Economic empowerment (EE) interventions have demonstrated substantial promise in reducing HIV-related risk-taking behaviors, and improving ART treatment adherence and mental health outcomes. Based on 10+ years of research utilizing savings-led EE interventions focused on HIV prevention, care and support for AY affected by HIV [AYaAIDS] (including AY living with HIV [AYLHIV]; and AY orphaned by AIDS [AYoAIDS] in SSA, our group has demonstrated the effectiveness of a multi-component EE intervention, Bridges, in four NIH-funded randomized control trials (RCT) in Uganda (R01 HD070727, R01HD074949, R34MH081763, R01MH113486), and one foundation-funded study in Kenya. Bridges involves: 1) financial literacy training (FLT) and mentorship; 2) family income-generating activities (IGA); and 3) incentivized savings via a matched Youth Development Account (YDA). Bridges has demonstrated robust effects on HIV-related risk-taking behaviors, ART adherence, mental health, psychosocial outcomes, educational achievement, family economics, and family cohesion. Yet, scaling EE interventions has been a challenge, signaling the need to identify and test scale-up strategies and examine determinants of implementation and sustainment. In Bridges2Scale, we will compare two multifaceted strategies (standard vs enhanced) for scaling Bridges in a two-arm Hybrid III effectiveness-implementation cluster RCT. The standard implementation strategy has been applied in our prior RCTs and involves educational meetings that prepare staff to deliver Bridges with minimal disruption to site workflow. This will be compared to an enhanced strategy that will be developed using Implementation Mapping. We will use the public school system to recruit 1440 AYaAIDS (ages 13-17 years) from 48 schools in the Greater Masaka region of Uganda, a region with 11.7% HIV prevalence. Schools will be the unit of randomization (n=24 schools per arm; n=720 students per arm). Four specific aims guide our study: Aim 1. Compare the implementation effectiveness of the standard implementation strategy vs. an enhanced implementation strategy; Aim 2. Determine the clinical effectiveness of Bridges implemented via a standard vs. enhanced implementation strategy; Aim 3. Explore implementation processes, mechanisms, and determinants; and Aim 4. Compare the cost and cost-effectiveness of the two implementation strategies. The study will address a critical challenge: how to best support the implementation, scale-up, and sustainment of EE interventions, which have been proven to be highly efficacious in improving youth-focused HIV prevention, care, and support outcomes, but are yet to be widely scaled up.

项目摘要 撒哈拉以南非洲（SSA）是一个以低资源社区和相对贫困家庭为主的地区， 艾滋病毒在青少年中的流行率不断上升。家庭经济困难加剧 AY参与危害健康行为的风险以及他们对护理的参与度低。这 增加了他们感染和传播艾滋病毒以及不坚持抗逆转录病毒治疗的风险。经济 增强权能（EE）干预措施在减少艾滋病毒相关风险方面显示出巨大的希望 行为，并改善ART治疗依从性和心理健康结果。基于10多年的经验 研究利用储蓄主导的EE干预措施，重点是艾滋病毒预防，护理和支持受影响的AY 艾滋病毒[AYaAIDS]（包括艾滋病毒感染者[AYLHIV];和艾滋病孤儿[AYoAIDS]在SSA，我们的小组 在四个NIH资助的项目中， 乌干达的随机对照试验（RCT） （R01） HD 070727、R01HD 074949、R34MH 081763、R01MH 113486）， 以及一项在肯尼亚的基金会资助的研究。桥梁包括：1）金融扫盲培训（FLT）和导师制; 2)家庭创收活动（伊加）;以及3）通过匹配的青年发展激励储蓄 账户（YDA）。布里奇斯已经证明了对艾滋病毒相关的冒险行为，ART依从性， 心理健康、心理社会结果、教育成就、家庭经济和家庭凝聚力。然而， 扩大EE干预措施一直是一个挑战，表明需要确定和测试扩大战略， 审查执行和维持的决定因素。在Bridges 2Scale中，我们将比较两个多方面 在双臂混合III有效性实施中扩展桥接器的策略（标准与增强） 集群RCT。标准实施策略已在我们之前的RCT中应用，并涉及教育 召开会议，让员工做好准备，在最大程度上减少对现场工作流程的干扰的情况下交付桥梁。这将与 将使用实施映射制定的增强型战略。我们将使用公立学校系统 从乌干达大马萨卡地区的48所学校招募1 440名艾滋病患者（13至17岁）， 艾滋病感染率为11.7%。学校将作为随机化单位（每组n=24所学校; n=720名学生 每臂）。四个具体目标指导我们的研究：目标1。比较标准的实施效果 实施战略与强化实施战略;目标2。确定临床有效性 通过标准与增强的实施战略实施的桥梁;目标3。探索实施 过程、机制和决定因素;目标4。比较两者的成本和成本效益 执行战略。这项研究将解决一个关键的挑战：如何最好地支持执行， 扩大和维持环境教育干预措施，这已被证明是非常有效的改善， 这是一项以青年为重点的艾滋病毒预防、护理和支助成果，但尚未广泛推广。