iTransition: Developing and Pilot Testing a Multilevel Technology-Based Intervention to Support Youth Living with HIV from Adolescent to Adult Care

摘要 13至24岁的青年在美国艾滋病毒流行中所占比例过高; 2015年，22%的艾滋病毒感染发生在这个年龄段。青年艾滋病毒感染者（YLH） 在艾滋病毒护理连续体的所有阶段参与护理的障碍。的过渡 从儿童/青少年到成人护理环境可能特别具有破坏性。但是，没有证据表明- 基于干预的研究显示，YLH的医疗过渡（HCT）临床结局得到改善。我们建议 开发和试点iTransition，这是一种基于移动的网站的干预措施，适用于YLH及其提供者，以改善HCT 在患者、提供者和诊所层面。为了最大限度地实现文化和发展的一致性， 我们将召集一个设计团队，其中包括YLH和医疗保健提供者，他们将告知 制定干预内容和实施战略。使用迭代设计和开发 在这一过程中，我们将开发符合YLH特定HCT需求的定制内容和活动。后 在开发干预措施时，我们将采用已建立的可用性测试程序来收集初步数据 从我们的设计团队对拟议的干预措施的设计和可接受性。设计团队中的供应商 还将被培训为“过渡冠军，鼓励和促进在他们的干预措施的吸收， 各自的诊所建议的更改将在启动 在亚特兰大的儿童/青少年和成人艾滋病毒临床护理中心进行实施试验， 费城该试验将使用混合方法评估干预的可行性和可接受性， YLH（N=50）和供应商（N=20）参与者。我们还将比较iTransition中YLH的临床结局 干预组（N=50）在HCT前后的12个月期间，与历史对照组的结局 （N=50），以收集初步疗效数据，为后续应用提供信息。具体目标包括： (1)开发iTransition，这是一种移动健康干预措施，旨在通过以下方式改善整个HCT的护理参与度： 针对青少年健康、儿童/青少年服务提供者和成人服务提供者的需要;以及（2）进行一项试验计划， iTransition与50个YLH和20个供应商，以收集有关可行性，可接受性和初步数据 改善HCT的功效。未来的方向包括一项全面的RCT，以测试iTransition在以下方面的疗效： 改善YLH的HCT后连续护理结局。

ABSTRACT Youth between the ages 13 and 24 are disproportionately represented in the United States HIV epidemic; in 2015, 22% of HIV infections occurred within this age group. Youth living with HIV (YLH) face significant barriers to care engagement across all stages of the HIV Care Continuum. The transition from pediatric/adolescent to adult-oriented care settings can be especially disruptive. Yet, there are no evidence- based interventions shown to improve healthcare transition (HCT) clinical outcomes for YLH. We propose to develop and pilot iTransition, a mobile website-based intervention for YLH and their providers to improve HCT at the patient, provider, and clinic levels. To maximize the cultural and developmental congruence of the intervention we will convene a Design Team that includes YLH and healthcare providers, who will inform the development of the intervention content and delivery strategies. Using an iterative design and development process, we will develop tailored content and activities that align with YLH-specific HCT needs. After developing the intervention, we will employ established usability testing procedures to collect preliminary data from our Design Team on the proposed intervention's design and acceptability. Providers on the Design Team will also be trained as “Transition Champions, encouraging and facilitating uptake of the intervention in their respective clinics. Recommended changes will be added to the intervention prior to launching an implementation trial based at pediatric/adolescent and adult-oriented HIV clinical care sites in Atlanta and Philadelphia. The trial will use a mixed-methods approach to assess intervention feasibility and acceptability for YLH (N=50) and provider (N=20) participants. We will also compare clinical outcomes of YLH in the iTransition intervention group (N=50) over the 12-month period around HCT, to outcomes of a historical comparison group (N=50), in order to gather preliminary efficacy data to inform a subsequent application. Specific Aims include: (1) To develop iTransition, an mHealth intervention designed to improve care engagement throughout HCT by targeting YLH, pediatric/adolescent providers’ and adult providers’ needs; and (2) To conduct a pilot trial of iTransition with 50 YLH and 20 providers, in order to collect data on feasibility, acceptability, and preliminary efficacy for improving HCT. Future directions include a fully powered RCT to test the efficacy of iTransition for improving post-HCT care continuum outcomes for YLH.