ZAIMARA: Zambian Informed Motivated Aware and Responsible Adolescents and Adults

扎马拉：赞比亚知情、积极、有意识、负责任的青少年和成年人

• 批准号: 10749138
• 负责人: Carolyn Bolton
• 金额: $ 96.85万
• 依托单位: CENTRE FOR INFECTIOUS DISEASE RESEARCH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-12 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749138
• 关键词: 18 year old; 19 year old; 2 arm randomized control trial; AIDS prevention; Address; Adherence; Adolescent; Adult; Area; Attention; Automobile Driving; Awareness; Chicago; Clinical; Clinical Research; Communities; Control Groups; Coupled; Distress; Ensure; Evidence based program; Exploration, Preparation, Implementation, and Sustainment; Failure; Feedback; Feeling; Female Adolescents; Focus Groups; Funding; Geography; Goals; Government; HIV; HIV Infections; HIV-infected adolescents; Health; Health Personnel; Health Promotion; Health Services; Hour; Human immunodeficiency virus test; Hybrids; Illinois; Incidence; Individual; Infection; Infectious Diseases Research; Intervention; Interview; Job Satisfaction; Logic; Medical; Mental Health; Methods; Minor; Modeling; Mothers; Occupations; Outcome; Participant; Patient Self-Report; Positioning Attribute; Prevalence; Primary Prevention; Program Sustainability; Province; Psyche structure; Public Health; Randomized; Research; Research Infrastructure; Resource-limited setting; Resources; Risk; Safe Sex; Sex Behavior; Sexually Transmitted Diseases; South Africa; Specific qualifier value; United States; United States National Institutes of Health; Universities; Viral; Workplace; Zambia; black women; burnout; catalyst; condoms; cost; design; dissemination science; effective intervention; effectiveness evaluation; effectiveness outcome; effectiveness/implementation trial; evidence base; follow-up; high risk; implementation outcomes; implementation research; implementation science; implementation strategy; informant; male; peer; performance site; pilot test; poor health outcome; pre-exposure prophylaxis; prevention service; programs; psychosocial; screening; sex; sexual risk taking; sexually active; social; stem; success; testing uptake; transmission process; treatment arm; uptake; working group; young woman

Project Abstract Zambia is struggling to meet the 95-95-95 targets for adolescent girls and young women (AGYW). HIV prevalence in 15-19 year-olds is 3.3%, and AGYW are 4 times more likely to acquire HIV than their male peers (8.6% vs. 2.1%). HIV incidence increased in AGYW from 2010-2020 while decreasing in all other groups, yet HIV testing rates are low (45.4%), and 71.2% do not know their HIV status. The proposed hybrid trial will evaluate the effectiveness and implementation of a CDC “best-evidence” intervention, Informed Motivated Aware and Responsible Adolescents and Adults (IMARA), recently adapted for South Africa (IMARA-SA) with promising effects on AGYW STI incidence, sexual risk taking, PrEP uptake, and mental health. Guided by the Exploration, Preparation, Implementation, Sustainment framework and an Implementation Research Logic Model, this study addresses a key driver of poor sustainability of evidence-based programs in low-resource settings - attrition in health workforce due to mental distress and low job satisfaction – by evaluating the impact of mental health screening and referral on peer leaders delivering IMARA. Building on preliminary focus groups with key stakeholders in Zambia, the study aims to: (1) Tailor IMARA-SA for the Zambian context to produce ZAIMARA; (2) Compare the effects of ZAIMARA vs. a general health promotion program on AGYW HIV testing uptake at 6 months (primary clinical outcome), incident STIs (including HIV), sexual behavior, and PrEP uptake (secondary clinical outcomes) at baseline, 6-, 12-, 18-, and 24 months. (3) Examine the impact of mental health screening and referral vs. a general check-in on peer leader job retention. (4) Evaluate ZAIMARA implementation outcomes using mixed methods and key informant interviews. The partnership between the Centre for Infectious Disease Research in Zambia (CIDRZ) and the Center for Dissemination and Implementation Science (CDIS) in the United States will ensure the expertise needed to complete the study in five geographically distinct communities in Lusaka Province, the region with the highest HIV prevalence in Zambia, while building capacity for implementation science research. This is a theoretically-grounded, hypothesis-driven hybrid-trial that addresses critical gaps in the HIV prevention continuum for Zambian AGYW, with a long-term goal to sustain effective programs that reduce HIV/STI infections.

项目摘要 赞比亚正在努力实现少女和青年妇女的95- 95-95目标。艾滋病毒 15-19岁的感染率为3.3%，年龄偏大的女青年感染艾滋病毒的可能性是同龄男性的4倍 (8.6%与2.1%）。从2010年至2020年，AGYW的艾滋病毒发病率增加，而所有其他群体的发病率则下降，但艾滋病毒 检测率低（45.4%），71.2%的人不知道自己的艾滋病毒状况。拟议的混合试验将评估 CDC“最佳证据”干预措施的有效性和实施情况，知情的动机意识和 负责任的青少年和成年人（IMARA），最近改编为南非（IMARA-SA）， 对AGYW性传播感染发病率、性风险、PrEP摄入和心理健康的影响。在探索的指引下， 准备，实施，维持框架和实施研究逻辑模型，这项研究 解决了在资源匮乏的环境中循证方案可持续性差的一个关键驱动因素-- 由于精神痛苦和工作满意度低而导致的卫生工作者-通过评估精神健康的影响 筛选和推荐同行领导人提供IMARA。在初步重点小组的基础上， 赞比亚的利益相关者，该研究旨在：（1）根据赞比亚的情况定制IMARA-SA以生成ZAIMARA;（2） 比较ZAIMARA与一般健康促进计划对AGYW艾滋病毒检测的影响， 月（主要临床结果），事件性传播感染（包括艾滋病毒），性行为和PrEP吸收（次要 在基线、6个月、12个月、18个月和24个月时的临床结局）。(3)检查心理健康筛查的影响， 推荐与一般检查在同行领导人的工作保留。(4)评估ZAIMARA实施成果， 混合方法和关键线人访谈传染病研究中心与 在赞比亚（CIDRZ）和传播和实施科学中心（CDIS）在美国将 确保在卢萨卡省五个地理位置不同的社区完成研究所需的专门知识， 在赞比亚艾滋病毒感染率最高的地区开展了一项研究，同时建设了实施科学研究的能力。 这是一项基于理论、假设驱动的混合试验，旨在解决艾滋病毒预防方面的关键差距。 赞比亚青年和女青年协会的长期目标是维持减少艾滋病毒/性传播感染的有效方案。