Implementation Science to Understand and Design Stakeholder Informed Innovative Interventions to Improve Adolescent and Youth HIV Prevention and Care Continuums in Rural and Urban Uganda

实施科学以理解和设计利益相关者知情的创新干预措施,以改善乌干达农村和城市青少年艾滋病毒预防和护理的连续性

基本信息

  • 批准号:
    10749472
  • 负责人:
  • 金额:
    $ 91.44万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2023
  • 资助国家:
    美国
  • 起止时间:
    2023-09-08 至 2028-08-31
  • 项目状态:
    未结题

项目摘要

PROJECT SUMMARY: Adolescents and young adults (AYA) have a high HIV incidence and poor outcomes along the entire HIV prevention and care cascades compared to adults. Despite the high HIV burden, both uptake of oral PrEP (HIV negatives) and achieving viral suppression (HIV positives) are sub-optimal among youth in Sub-Saharan Africa. Among youth in Uganda, uptake and persistence on oral PrEP is low, with reasons for discontinuation including: pill burden, low perceived severity of HIV, need for partner or parental approval, HIV- related stigma, fear of side-effects and health facility barriers. Cabotegravir, a is new long-acting antiretroviral (CAB-LA) and highly efficacious PrEP choice that can mitigate barriers to use of daily oral PrEP. We propose to evaluate evidence-based HIV prevention and care interventions to improve implementation outcomes among high-risk AYA (15-24 years) in Uganda. The study covers the continuum of care, will use novel screening methods for HIV risk, will involve teams that are highly experienced in youth-focused clinical trials and implementation science (ImS), will implement MOH approved community differentiated service delivery models for delivery CAB-LA, will evaluate the implementation of the SEARCH-Youth (SY), a multi-component intervention comprising of life-stage based assessment and support to increase viral suppression in high-risk AYA with HIV, and will use hybrid effectiveness implementation designs to assess these evidence-based interventions. Our aims include: Aim 1: Using the consolidated framework for implementation research (CFIR), we will identify determinants of potential implementation success of two innovations: CAB-LA and SY implementation at the community, clinic, provider, and patient levels in 5 geographically distinct sites in Uganda. Aim 2a: Using a hybrid effectiveness implementation type II design, we will assess the uptake and persistence of CAB-LA. We will conduct a randomized prospective study to assess effectiveness for the provision of CAB- LA among high risk AYA. Effectiveness outcome will be proportion of study subjects who have initiated CAB-LA and persisted at 18 months of follow-up comparing facility and community delivery options. Implementation outcomes will be feasibility, acceptability, adoption and maintenance using RE-AIM. Aim 2b: Using a hybrid effectiveness implementation type III design we will assess implementation (feasibility, adoption, fidelity, and sustainment) and effectiveness of the SY intervention in increasing long-term virologic suppression (<200 c/mL) at 18 months of follow-up in 5 CRPS using RE-AIM. Aim 3: We will use platforms in aims 1 and 2 to strengthen capacity of ImS and to translate findings into policy and guidelines. Our study involves solid community and institutional partnerships and builds on a strong multi-disciplinary team highly experienced in innovative methods and implementation science in sub-Saharan Africa. The project, building on PATC3H and AHISA, is responsive to WHO’s, Uganda’s MoH priorities regarding the gap in HIV services for highly vulnerable AYA. It will test a novel, scalable and integrated approach to initiate and sustain support for high-risk AYA in LMIC.
项目摘要:青少年和年轻人(AYA)的艾滋病毒感染率很高,结果很差 沿着整个艾滋病预防和护理级联。尽管艾滋病毒负担很高, 口服PrEP(HIV阴性)和实现病毒抑制(HIV阳性)在青年中是次优的, 撒哈拉以南非洲在乌干达的青年中,口服PrEP的吸收和持续性很低,原因是 停药包括:药物负担、艾滋病毒严重程度低、需要伴侣或父母批准、艾滋病毒- 相关的耻辱、对副作用的恐惧和卫生设施障碍。 Cabotegravir,a是一种新型长效抗逆转录病毒药物 (CAB-LA) 和高度有效的PrEP选择,可以减轻每日口服PrEP的使用障碍。我们建议 评估循证艾滋病毒预防和护理干预措施,以改善 乌干达的高风险AYA(15-24岁)。该研究涵盖了连续护理,将使用新型筛查 艾滋病毒风险的方法,将涉及在以青年为重点的临床试验方面经验丰富的团队, 实施科学(ImS),将实施卫生部批准的社区差异化服务提供模式 对于交付CAB-LA,将评估SEARCH-青年(SY)的执行情况,这是一个多组成部分, 干预包括基于生命阶段的评估和支持,以增加高风险患者的病毒抑制 AYA与艾滋病毒,并将使用混合有效性实施设计,以评估这些循证 干预措施。我们的目标包括:目标1:使用实施研究的综合框架(CFIR), 我们将确定两项创新的潜在实施成功的决定因素:CAB-LA和SY 在乌干达的5个地理位置不同的地点,在社区、诊所、提供者和患者层面实施。 目标2a:使用混合有效性实施类型II设计,我们将评估 的CAB-LA。我们将进行一项随机前瞻性研究,以评估提供CAB的有效性- 高风险的AYA有效性结局将是开始CAB-LA的研究受试者比例 并坚持在18个月的随访比较设施和社区交付的选择。执行 结果将是使用RE-AIM的可行性、可接受性、采用和维护。目标2b:使用混合动力车 有效性实施类型III设计我们将评估实施(可行性、采用性、保真度和 维持)和SY干预在增加长期病毒学抑制(<200 c/mL)方面的有效性 在18个月随访时,5例CRPS使用RE-AIM。目标3:我们将利用目标1和目标2中的平台, 提高信息管理系统的能力,并将研究结果转化为政策和指导方针。我们的研究涉及坚实的社区, 机构伙伴关系,并建立在一个强大的多学科团队,在创新方法方面经验丰富 在撒哈拉以南非洲的科学和实施。该项目以PATC 3 H和AHISA为基础, 与世卫组织相比,乌干达卫生部在为高度脆弱的艾滋病毒感染者提供艾滋病毒服务方面存在差距。它将测试A 一种新颖、可扩展的综合方法,用于启动和维持对LMIC中高风险AYA的支持。

项目成果

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Philippa Musoke其他文献

Philippa Musoke的其他文献

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{{ truncateString('Philippa Musoke', 18)}}的其他基金

Hospital-based birth defects surveillance in Kampala, Uganda
乌干达坎帕拉的医院出生缺陷监测
  • 批准号:
    9768286
  • 财政年份:
    2016
  • 资助金额:
    $ 91.44万
  • 项目类别:
Hospital-based birth defects surveillance in Kampala, Uganda
乌干达坎帕拉的医院出生缺陷监测
  • 批准号:
    10086352
  • 财政年份:
    2016
  • 资助金额:
    $ 91.44万
  • 项目类别:
Feasibility and Cost of WHO PMTCT Option A vs. B in Rural and Urban Uganda
世卫组织预防母婴传播方案 A 与 B 在乌干达农村和城市的可行性和成本
  • 批准号:
    8261540
  • 财政年份:
    2012
  • 资助金额:
    $ 91.44万
  • 项目类别:
Feasibility and Cost of WHO PMTCT Option A vs. B in Rural and Urban Uganda
世卫组织预防母婴传播方案 A 与 B 在乌干达农村和城市的可行性和成本
  • 批准号:
    8579800
  • 财政年份:
    2012
  • 资助金额:
    $ 91.44万
  • 项目类别:
DEVELOPING SUSTAINABLE HIV CLINICAL TRIALS RESEARCH CAPACITY IN UGANDA
发展乌干达可持续的艾滋病毒临床试验研究能力
  • 批准号:
    7806427
  • 财政年份:
    2009
  • 资助金额:
    $ 91.44万
  • 项目类别:
DEVELOPING SUSTAINABLE HIV CLINICAL TRIALS RESEARCH CAPACITY IN UGANDA
发展乌干达可持续的艾滋病毒临床试验研究能力
  • 批准号:
    7680449
  • 财政年份:
    2009
  • 资助金额:
    $ 91.44万
  • 项目类别:
DEVELOPING SUSTAINABLE HIV CLINICAL TRIALS RESEARCH CAPACITY IN UGANDA
发展乌干达可持续的艾滋病毒临床试验研究能力
  • 批准号:
    8116329
  • 财政年份:
    2009
  • 资助金额:
    $ 91.44万
  • 项目类别:

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