Self-Management among adolescents living with HIV in Uganda

项目总结/摘要 乌干达有超过73，000名青少年感染艾滋病毒（ALHIV），占全球的4%。 艾滋病毒的人口。尽管艾滋病毒广泛存在，但它仍然是青少年死亡的主要原因 抗逆转录病毒药物一般来说，ALHIV的预后较差，失访率较高 与其他年龄组相比。在过渡时期，死亡率和失访率最高。 对于那些准备更好地在成人艾滋病毒诊所谈判护理的ALHIV， 设置.这种准备可以包括技能培训，以提高自我效能，弹性和教育， 解决艾滋病毒知识缺乏的问题，这两者都预示着过渡后会有更好的结果。提供 提供心理社会支持和准备信息，以指导成人艾滋病毒护理服务， 与成功转型有关。建议的K43应用程序的总体目标是补充我 精神病学的临床背景，高级课程和行为科学的重点指导， 制定和测试行为干预措施，以改善护理过渡。这次训练能让我 为了实现我的科学目标：开发和测试ALHIV过渡的自我管理干预措施 成人艾滋病护理。这项训练将使我能够实现我的科学目标：发展和测试自我- 对艾滋病病毒的管理干预。本申请建议开发一种自我管理干预措施， ALHIV过渡到成人艾滋病毒护理，并测试干预措施对艾滋病毒结果的影响。开展 本申请中提出的研究将补充我之前在精神病学方面的培训，同时填补以下方面的关键空白： 三个领域：（a）行为科学理论及其在行为干预中的应用，（B）适应， 行为干预措施的设计，以及（c）通过随机试验测试行为干预措施。填补 这些差距，我将进行定性研究，阐述所面临的障碍的概念框架， 在乌干达，ALHIV向成人艾滋病毒护理过渡（目标1），制定自我管理干预措施， 使ALHIV能够成功地过渡到成人HIV护理（目标2），并评估可行性、可接受性和 自我管理干预对ALHIV向成人HIV转化的HIV结局的初步影响 护理（目标3）。这项研究将是第一个开发一个自我管理干预针对关键的 在撒哈拉以南非洲从儿科到成人艾滋病毒护理的过渡时期， 旨在测试自我管理干预对乌干达ALHIV患者健康结果的影响， 正在向成人艾滋病护理过渡。这些发现将通过优化健康状况， 艾滋病是全球艾滋病毒流行病中的一个关键人群。拟议的研究将作为基础， 竞争性R 01赠款提案，在第4年提交，进行充分的动力，随机对照试验， 评估行为干预的有效性，以改善护理和病毒抑制的保留 在乌干达的ALHIV患者中，他们正处于向成人艾滋病毒护理过渡的关键时期。

PROJECT SUMMARY/ABSTRACT There are over 73,000 adolescents living with HIV (ALHIV) in Uganda constituting 4% of the worldwide population of ALHIV. HIV remains a leading cause of death among adolescents despite widespread availability of antiretroviral medication. Generally, ALHIV have poor outcomes with higher rates of loss to follow up compared with other age groups. Mortality rates and loss to follow up are highest during the transition period. Transition success may be maximized for ALHIV who are better prepared to negotiate care in adult HIV clinic settings. This preparation can include skills training to improve self-efficacy, resilience, and education to address lack of HIV knowledge, both of which are predictive of better outcomes following transition. Provision of psychosocial support and preparatory information to navigate adult HIV care services have also been associated with successful transition. The overall goal of the proposed K43 application is to complement my clinical background in psychiatry with advanced coursework and focused mentoring in behavioral science and development and testing of behavioral interventions to improve transition in care. This training will enable me to achieve my scientific objective: to develop and test a self-management intervention for ALHIV transitioning to adult HIV care. This training will enable me to achieve my scientific objective: to develop and test a self- management intervention for ALHIV. This application proposes to develop a self-management intervention for ALHIV transitioning to adult HIV care and test the impacts of the intervention on HIV outcomes. Conducting the proposed studies in this application will complement my prior training in psychiatry while filling key gaps in three areas: (a) behavioral science theories and their application to behavioral interventions, (b) adaptation and design of behavioral interventions, and (c) testing of behavioral interventions through randomized trials. To fill these gaps, I will conduct qualitative research to elaborate a conceptual framework of the barriers faced by ALHIV transitioning to adult HIV care in Uganda (Aim 1), develop a self-management intervention that will enable ALHIV to successfully transition to adult HIV care (Aim 2), and assess feasibility, acceptability, and preliminary effects of the self-management intervention on HIV outcomes for ALHIV transitioning to adult HIV care (Aim 3). This study will be the first to develop a self-management intervention targeting the critical transition period from pediatric to adult HIV care in sub-Saharan Africa and the first to use a randomized design to test the effect of a self-management intervention on health outcomes among ALHIV in Uganda who are transitioning to adult HIV care. These findings will have significant public health impact by optimizing health outcomes for a key population in the global HIV epidemic. The proposed research will serve as the basis for a competitive R01 grant proposal, submitted in year 4, to conduct a fully-powered, randomized controlled trial to evaluate the effectiveness of a behavioral intervention to improve retention in care and viral suppression among ALHIV in Uganda who are navigating the critical period of transition to adult HIV care.