Bridges-Round 2: Evaluating the Long-term Impact of a Family Economic Empowerment Intervention on HIV Risk Prevention and Care Continuum Outcomes among Orphaned Youth Transitioning to Young Adulthood

Bridges-Round 2：评估家庭经济赋权干预措施对过渡到青年时期的孤儿青少年的艾滋病毒风险预防和护理连续结果的长期影响

• 批准号: 10593954
• 负责人: Proscovia Nabunya
• 金额: $ 58.4万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-17 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10593954
• 关键词: 14 year old; 16 year old; AIDS prevention; Acquired Immunodeficiency Syndrome; Adolescent; Adolescent and Young Adult; Affect; Africa South of the Sahara; Age; Alcohols; Behavior; Biological Markers; Caring; Childhood; Continuity of Patient Care; Cost-Benefit Analysis; Costs and Benefits; Data; Development; Economics; Education; Effectiveness; Employment; Enrollment; Family; Future; Goals; Guide prevention; HIV; HIV Infections; HIV Seronegativity; HIV antiretroviral; HIV risk; HIV/AIDS; Health; Health behavior; Home; Human immunodeficiency virus test; Incidence; Intervention; Investments; Knowledge; Life; Life Cycle Stages; Long-Term Effects; Male Circumcision; Marriage; Measures; Medical; Mental Health; Outcome; Parents; Participant; Patient Self-Report; Perception; Performance; Personal Satisfaction; Persons; Policies; Population; Poverty; Prevalence; Prevention; Primary Schools; Program Sustainability; Public Health; Research; Resource-limited setting; Resources; Risk; Risk Behaviors; Risk Taking; Rural; Schools; Sex Behavior; Sexual Health; Sexually Transmitted Diseases; Social Controls; Social support; Testing; Translating; Uganda; United States National Institutes of Health; Viral; Viral Load result; Well in self; Work; Youth; adverse childhood events; age group; alcohol misuse; antiretroviral therapy; behavioral health; behavioral outcome; boys; cohort; cost; drug misuse; early adolescence; economic evaluation; empowerment; experience; experimental study; girls; improved; innovation; longitudinal dataset; migration; poor health outcome; pre-exposure prophylaxis; premature; primary outcome; programs; reproductive; response; retention rate; scale up; secondary analysis; sexual risk behavior; sexual risk taking; social disparities; social stigma; success; therapy adherence; treatment adherence; young adult

PROJECT ABSTRACT Globally, adolescents and young adults (AYA; ages 14-29) represent 30% of HIV incidence cases among persons of reproductive age, with ~75% occurring in Sub Saharan Africa (SSA). HIV incidence rises rapidly in SSA, as AYA leave school (often prematurely) and migrate for work and marriage. Older adolescents are more likely to experiment with health compromising behaviors that increase their vulnerability to HIV and sexually transmitted infections (STIs). Young people orphaned by AIDS [YPoAIDS]), 80% of which live in SSA represent a particularly vulnerable and unique population. Most YPoAIDS in SSA experience immense hardships, including higher rates of HIV risk behavior and odds of HIV infection. These adversities cumulatively disrupt the developmental milestones for YPoAIDS and can compromise their health and emotional wellbeing. Notably, our team has had great success with implementing a 6-year, three-armed RCT that tested a family-based economic intervention, Bridges (R01HD070727), among 1,383 primary school going adolescents in rural Uganda (10-14 years of age at enrollment) who lost one or both parents to AIDS. With over 90% retention rate over a 6-year period (2012-2018), our findings show efficacy of this contextually-driven intervention significantly improving sexual health, school retention and performance, and mental health. Yet, two critical policy and programming questions related to HIV prevention and engagement in care continuum remain unaddressed: 1) longer-term effectiveness of Bridges across YPoAIDS’s life course is currently unknown but critically important because of unique vulnerabilities during the transition into young adulthood; and 2) self-reports of sexual health are unreliable, hence the need to integrate biomarkers to provide the most precise results of these highly relevant (but currently unknown) sexual health outcomes among our participants. Thus, the specific aims of the Bridges- Round 2 study are: Aim 1. Examine the long-term impact of Bridges on: HIV prevalence (measured via participant’s HIV status) (Primary outcome); and b) Explore in secondary analyses the long-term impact of Bridges on key developmental and behavioral outcomes (e.g., mental health, alcohol and drug misuse); Aim 2. Elucidate the long-term effects of Bridges on potential mechanisms of change, including: a) economic stability, viral suppression (for ALHIV); PrEP use (for HIV negative adolescents), medical male circumcision (for boys); and b) young adult transitions; Aim 3: Qualitatively investigate participants’ experiences with Bridges that may have influenced engagement with the program, sexual risk-taking decisions, financial behaviors; experiences with developmental transitions; and perceptions on program sustainability; Aim 4: To assess the long-term costs and benefits of Bridges using formal economic evaluation. Our long-term goal is to translate knowledge into sustainable, theoretically-guided prevention and treatment efforts that promote the wellbeing of AYA affected by HIV/AIDS across the life course, in low-resource settings.

项目摘要 在全球范围内，青少年和青年人（AYA；14-29 岁）占艾滋病毒感染病例的 30% 育龄人口，其中约 75% 发生在撒哈拉以南非洲 (SSA)。艾滋病毒发病率迅速上升 SSA，AYA 离开学校（通常过早）并为了工作和结婚而移民。年长的青少年更多 可能会尝试危害健康的行为，从而增加他们感染艾滋病毒和性行为的可能性 传播感染（STI）。因艾滋病而成为孤儿的年轻人 [YPoAIDS]），其中 80% 生活在 SSA 特别脆弱和独特的人群。 SSA 的大多数 YPoAIDS 经历了巨大的困难，包括 艾滋病毒危险行为的发生率和感染艾滋病毒的几率更高。这些逆境累积起来扰乱了 YPoAIDS 的发展里程碑，可能会损害他们的健康和情感福祉。值得注意的是，我们的 团队在实施一项为期 6 年的三臂随机对照试验方面取得了巨大成功，该试验测试了以家庭为基础的经济 Bridges 干预措施 (R01HD070727)，针对乌干达农村地区 1,383 名上小学的青少年（10-14 岁） 入学时的年龄）因艾滋病而失去父母之一或双亲的人。 6年保留率超过90% 期间（2012-2018），我们的研究结果表明，这种情境驱动的干预措施的有效性显着提高 性健康、学业成绩和表现以及心理健康。然而，两项关键政策和规划 与艾滋病毒预防和参与护理连续性相关的问题仍未得到解决：1）长期 跨越 YPoAIDS 生命历程的桥梁的有效性目前尚不清楚，但至关重要，因为 向青年期过渡期间的独特脆弱性； 2) 性健康自我报告 不可靠，因此需要整合生物标记物以提供这些高度相关的最精确结果 （但目前未知）我们参与者的性健康结果。因此，桥梁的具体目标是： 第 2 轮研究是： 目标 1. 检查 Bridges 对以下方面的长期影响： HIV 患病率（通过测量 参与者的艾滋病毒状况）（主要结果）； b) 在二次分析中探讨以下因素的长期影响： 关键发展和行为结果（例如心理健康、酒精和药物滥用）的桥梁；目标2。 阐明桥梁对潜在变革机制的长期影响，包括：a) 经济稳定性， 病毒抑制（针对 ALHIV）； PrEP 的使用（针对 HIV 阴性青少年）、医疗男性包皮环切术（针对男孩）； b) 青少年过渡；目标 3：定性调查参与者的桥梁体验 影响了对计划的参与、性冒险决策、财务行为；经历 随着发展的转变；以及对计划可持续性的看法；目标 4：评估长期成本 以及使用正式经济评估的桥梁的好处。我们的长期目标是将知识转化为 可持续的、有理论指导的预防和治疗工作，以促进受该病影响的 AYA 的福祉 在资源匮乏的环境中，艾滋病毒/艾滋病贯穿生命全程。