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，青少年和年轻成年人（14-29岁）占艾滋病毒感染病例的30%， 育龄妇女，约75%发生在撒哈拉以南非洲（SSA）。艾滋病发病率迅速上升， SSA，作为AYA离开学校（通常过早）和迁移工作和婚姻。年龄较大的青少年 可能会尝试危害健康的行为，增加他们对艾滋病毒和性行为的脆弱性。 传播感染（STI）。因艾滋病而成为孤儿的年轻人，其中80%生活在撒南非洲， 一个特别脆弱和独特的群体。撒南非洲的大多数青年艾滋病患者都经历了巨大的困难， 艾滋病毒风险行为和艾滋病毒感染几率更高。这些不利因素累积起来， YPoAIDS的发展里程碑，并可能损害他们的健康和情感健康。值得注意的是，我们的 一个团队在实施一项为期6年的三臂RCT方面取得了巨大成功，该RCT测试了一个以家庭为基础的经济 干预，桥梁（R 01 HD 070727），在乌干达农村的1,383名小学生中（10-14岁） 年龄在入学时）谁失去了一个或双方的父母艾滋病。6年内留存率超过90% 期间（2012-2018年），我们的研究结果显示，这种背景驱动的干预措施的有效性显着提高 性健康、在学率和成绩以及心理健康。然而，两个关键的政策和规划， 与艾滋病毒预防和参与护理连续体有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 在过渡到年轻的成年人的独特脆弱性;和2）自我报告的性健康是 不可靠，因此需要整合生物标志物，以提供这些高度相关的最精确的结果。 (but目前未知）我们的参与者之间的性健康结果。因此，桥梁的具体目标- 第2轮研究是：目标1。审查桥梁对以下方面的长期影响：艾滋病毒流行率（通过 参与者的HIV状态）（主要结局）;和B）在次要分析中探索 关键发展和行为结果的桥梁（例如，精神健康、酒精和药物滥用）;目标2。 阐明桥梁对潜在变化机制的长期影响，包括：a）经济稳定， 病毒抑制（用于ALHIV）; PrEP使用（用于HIV阴性青少年），医学男性包皮环切术（用于男孩）; 和B）年轻人的过渡;目标3：质量调查参与者的经验与桥梁， 影响了参与该计划，性风险决策，财务行为;经验 与发展过渡;和对计划可持续性的看法;目标4：评估长期成本 和效益的桥梁使用正式的经济评估。我们的长期目标是将知识转化为 可持续的，理论指导的预防和治疗工作，促进受影响的AYA的福祉 艾滋病毒/艾滋病在整个生命过程中，在低资源环境中。