VS4A: VITAL Start (Video-Intervention to Inspire Treatment Adherence for Life) for Adolescents, a video intervention to improve retention and adherence to ART among adolescents living with HIV

项目摘要/摘要 全球170万青少年艾滋病毒携带者迫切需要干预措施来帮助改善 保留、坚持，并最终抑制病毒载量(VLS)。既有很高的感染率，也有 ALHIV的死亡率很高，每天大约有100人死亡，这是VLS发病率最低的一种。 低收入和中等收入国家改善ALHIV病毒携带率和VLS的成功干预 (LMIC)仍有限。为艾滋病毒感染者提供咨询的基于视频的干预措施 增加患者对艾滋病毒的了解，支持披露，促进行为改变，改善治疗 坚持不懈。有针对性的信息可以编织成与文化相关的电影，具有引人入胜的故事情节和 在关键的可教时刻授课。电影可以在大容量的诊所放映，以提供标准化的 咨询内容，同时腾出HCW时间。虽然基于视频的干预有可能解决 阻碍ALHIV抗逆转录病毒药物保留和坚持的障碍，它们在整个撒哈拉以南非洲地区并不常用 (SSA)。我们的团队是第一批试点和研究基于视频的干预对艾滋病毒服务的影响的团队之一 分娩；初步结果表明患者和HCW的满意度很高，改善了ART 知识、坚守和保持。基于这些有希望的结果，我们建议适应、评估和 支持扩大针对ALHIV的量身定制的基于视频的咨询包：VITAL(视频干预以激励 终身坚持治疗)青少年开始(VS4A)。我们的研究将考察VS4A对 在多部位双臂中保留和黏附(病毒载量和1000拷贝/毫升)的主要综合结果 马拉维1：1随机分组随机对照试验(CRCT)。我们的总体假设是 VS4A将a)实现广泛的影响，b)可接受和可行的实施，c)改善青少年 VLS和若干次级成果；以及d)在规模上具有成本效益。如果有效，VS4A可以成为一种 创新、可扩展的工具，可改善ALHIV的服务交付，同时解放HCW时间并减少 马拉维的卫生系统负担。在与马拉维卫生部(MOH)15年合作伙伴关系的基础上， 在服务于ALHIV方面的卓越和创新的跟踪记录，以及强有力的实施科学研究 我们的团队准备成功地实施VS4A研究和计划，并利用发现来 支持快速、大范围传播和扩大规模。

PROJECT SUMMARY/ABSTRACT The 1.7 million adolescents living with HIV (ALHIV) globally urgently need interventions to help improve retention, adherence, and ultimately viral load suppression (VLS). With both high rates of incident infection and some of the lowest VLS rates, ALHIV experience high mortality with approximately 100 deaths per day. Successful interventions to improve retention and VLS among ALHIV in low- and middle-income countries (LMIC) remain limited. Video-based interventions that provide counseling to patients living with HIV have increased patient HIV knowledge, supported disclosure, fostered behavior change, and improved treatment adherence. Targeted messaging can be woven into culturally relevant films with engaging storylines and delivered at critical teachable moments. Films can be shown in high-volume clinics to deliver standardized counseling content while freeing up HCW time. While video-based interventions have the potential to address barriers to ALHIV ART retention and adherence, they are not commonly used throughout Sub-Saharan Africa (SSA). Our team was one of the first to pilot and study the impact of a video-based intervention on HIV service delivery; preliminary results have suggested high levels of patient and HCW satisfaction, improved ART knowledge, adherence, and retention. Based on these promising results, we propose to adapt, assess and support scale up of a tailored, video-based counseling package for ALHIV: VITAL (Video Intervention to Inspire Treatment Adherence for Life) Start for Adolescents (VS4A). Our study will examine the impact of VS4A on the primary composite outcome of retention and adherence (viral load <1000 copies/ml) in a multisite two-arm cluster randomized controlled trial (CRCT) with 1:1 randomization in Malawi. Our overall hypothesis is that VS4A will a) achieve broad reach, b) be acceptable and feasible to implement, c) improve adolescent VLS and several secondary outcomes; and d) be cost-effective at scale. If effective, VS4A can be an innovative, scalable tool to improve service delivery for ALHIV while also liberating HCW time and reducing health system burden in Malawi. Building on a 15-year partnership with the Malawi Ministry of Health (MOH), a track record of excellence and innovation in service to ALHIV, and a robust implementation science research portfolio, our team is poised to successfully implement the VS4A study and program and to use findings to support rapid, wide-scale dissemination and scale up.