Improving Retention in Care for Adolescents and Young Adults in Kenya: Implementation Science to Support Adaptation and Integration of a Stepped Care Intervention

提高肯尼亚青少年和年轻人的护理保留率：实施科学以支持阶梯式护理干预措施的适应和整合

• 批准号: 10636805
• 负责人: Nok Chhun
• 金额: $ 4.7万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-16 至 2025-06-15
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636805
• 关键词: Address; Adolescent; Adolescent and Young Adult; Adoption; Adult; Africa South of the Sahara; Caring; Categories; Characteristics; Client; Consolidated Framework for Implementation Research; Data; Development; Effectiveness of Interventions; Eligibility Determination; Ensure; Evaluation; Evidence based intervention; Failure; Feedback; Focus Groups; Frequencies; Friends; Future; Goals; HIV; HIV Infections; HIV-infected adolescents; Health Personnel; Health Services; Health care facility; Health system; Healthcare Systems; Individual; Intervention; Interview; Kenya; Measures; Methodology; Methods; Modeling; Modification; Nature; Outcome; Parents; Penetration; Perception; Persons; Phase; Procedures; Process; Qualitative Methods; Randomized, Controlled Trials; Readiness; Recommendation; Reporting; Research; Research Personnel; Resource-limited setting; Resources; Risk; Service delivery model; Services; Surveys; Testing; Time; Time Series Analysis; Training; Treatment outcome; Variant; Viral; Youth; clinical predictors; community based care; design; doctoral student; effectiveness evaluation; evidence base; follow-up; health care settings; health empowerment; high-risk adolescents; implementation determinants; implementation evaluation; implementation facilitators; implementation intervention; implementation outcomes; implementation science; implementation strategy; improved; meetings; mortality; post intervention; pre-doctoral; predictive tools; preference; risk prediction; routine practice; scale up; service delivery; skills; social; success; treatment adherence; trend

Abstract Worldwide, five million adolescents and young adults (AYA) are living with HIV. More than 90% of global HIV- related mortality among AYA occurs in sub-Saharan Africa. A limited but growing evidence base of interventions available for adolescents in sub-Saharan Africa highlight the importance of retention in care for improving treatment outcomes. To meet AYA where they are in their engagement with the healthcare system, interventions need to be feasible, acceptable, and appropriate for local healthcare settings and practice. This F31 project leverages a cluster randomized controlled trial, Data-informed Stepped Care to Improve Adolescent HIV Outcomes (UG3/UH3 HD096906; PIs: Kohler, John-Stewart) that is testing a Stepped Care intervention to improve retention among adolescents and young adults living with HIV in western Kenya. This F31 project aims to evaluate early phase implementation outcomes of the Stepped Care intervention as it is delivered across 10 healthcare facilities. Aim 1 will identify adaptations made to the intervention (materials, procedures, or delivery) that influence acceptability, feasibility, and appropriateness. The Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) will be used to characterize adaptations and modifications necessary for facility-specific optimization of the intervention. Aim 2 will identify the barriers and facilitators that impact penetration, coverage, and fidelity of the Stepped Care intervention. We will apply the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators of implementation to understand the context and intervention characteristics influencing implementation of the Stepped Care intervention. Finally, Aim 3 will match barriers to successful implementation to targeted strategies to overcome them, producing a package of intervention implementation options that promote long-term intervention adoption and sustainability. Findings from this project will contribute to understanding optimization of Stepped Care and provide valuable information about the context necessary for successful scale-up of Stepped Care interventions for adolescents and young adults within Kenya or scale out to other global settings. The research plan will provide the F31 candidate, an implementation science pre-doctoral student, with rigorous training in (1) implementation science conceptual frameworks, models, design and methodology; (2) training in qualitative methods; and (3) content-area expertise regarding evidence-based interventions for adolescents and young adults living with HIV.

摘要 全世界有500万青少年和年轻成年人（AYA）感染艾滋病毒。全球90%以上的艾滋病毒感染者- AYA的相关死亡率发生在撒哈拉以南非洲。干预措施的证据基础有限但不断增加 为撒哈拉以南非洲青少年提供的服务强调了保持护理对改善 治疗结果。为了满足AYA在他们参与医疗保健系统，干预措施， 需要对当地医疗环境和实践可行、可接受和适当。F31项目 利用一项群集随机对照试验，数据知情的分步护理，以改善青少年艾滋病毒 结局（UG 3/UH 3 HD 096906; PI：科勒、John-Stewart），正在测试阶梯式护理干预， 提高肯尼亚西部感染艾滋病毒的青少年和年轻人的保留率。F31项目旨在 评估阶梯式护理干预的早期实施结果，因为它是在10个 医疗设施。目标1将确定对干预（材料、程序或交付）的调整 影响可接受性、可行性和适当性。报告调整框架和 对循证干预措施（FRAME）的修改将用于描述适应性， 对干预措施的设施特定优化所需的修改。目标2将确定障碍， 影响阶梯式护理干预的渗透率、覆盖率和忠诚度的促进者。我们将应用 执行研究综合框架，审查执行研究的障碍和促进因素 执行情况，以了解影响执行《行动纲领》的背景和干预措施的特点， 阶梯式护理干预。最后，目标3将把成功实施的障碍与有针对性的战略相匹配 以克服这些问题，制定一揽子干预实施方案， 干预措施的采用和可持续性。这个项目的发现将有助于理解优化 并提供关于成功扩大 为肯尼亚境内的青少年和年轻人提供阶梯式护理干预措施，或扩大到其他全球环境。 该研究计划将提供F31候选人，一个实施科学博士前的学生，与严格的 （1）实施科学概念框架、模型、设计和方法方面的培训;（2） 定性方法;（3）关于青少年循证干预措施的内容领域专门知识， 感染艾滋病毒的年轻人。