Adapting and testing a combination peer navigation and mHealth intervention to enhance treatment engagement and viral suppression among sexual and gender minority youth in Nigeria

项目摘要 尼日利亚是全球青年艾滋病毒感染者负担的六个国家之一。的艾滋病毒感染率 与男性发生性关系的年轻男性（YMSM）和年轻变性女性（YTW），年龄在15-24岁之间， 这是青年人的普遍需求。此外，在所有风险群体中， 与成人相比，艾滋病毒护理结果。治疗参与和病毒感染面临挑战 YMSM和YTW之间的抑制。虽然成人艾滋病毒护理通常从15岁开始， 支持成功护理参与的计划很少，特别是对于YMSM和YTW，他们通常 更喜欢在多功能的重点人群为重点的社区中心接受护理，这些中心往往缺乏 以证据为导向的针对青年的干预措施，包括社会心理和药物依从性支持， 最好的结果。考虑到该国的经济状况，这种对以人口为重点的社区中心的偏好是合理的。 不利的社会环境，促进社会耻辱，缺乏披露，低社会支持，并在 这是一个将同性关系定为犯罪的法律的环境。循证和可扩展 需要采用结合社区中心偏好的方法对ART产生最大影响 在尼日利亚的YMSM和YTW之间的结果。因此，我们建议调整和测试密集组合 尼日利亚艾滋病毒流行病逆转办法（iCARE尼日利亚），以改善艾滋病毒治疗的参与， YMSM和YTW在接受治疗时的药物依从性和病毒抑制。iCARE 尼日利亚模式采用基于证据和针对青年的方法，包括同行导航和每日文本 消息提醒组合。iCARE尼日利亚已在一般青年人群中证明了疗效 在尼日利亚伊巴丹大学的一个传统的艾滋病诊所里，在本研究中，我们将其扩展到YMSM 而YTW在社区中心采用社区和外展服务方式提供照顾。我们的目标 是为YMSM和YTW开发一种实用和可扩展的艾滋病毒治疗方法， 在乎我们的目标是：1）使iCARE尼日利亚艾滋病毒诊所为基础的干预措施适应社区为基础的干预措施， 尼日利亚伊巴丹15-24岁的YMSM和YTW艾滋病毒感染者的外展方法; 2）测试适应的 iCARE干预在YMSM和YTW中的初步疗效、可行性、满意度和可接受性，以及3） 根据RE-AIM（覆盖、采用、实施、维护）评估实施指标， 为经过调整的iCARE尼日利亚干预措施的广泛传播和可扩展性提供信息。

Project Summary Nigeria is one of the six countries with half of the global burden of youth with HIV. HIV prevalence among young men who have sex with men (YMSM) and young transgender women (YTW), ages 15-24 is over six-fold that of the general population of youth. Furthermore, across risk groups, youth have disproportionately worse HIV care outcomes in comparison to adults. There are challenges to treatment engagement and viral suppression among YMSM and YTW. While adult HIV care routinely begins at age 15, youth-adapted programs to support successful care engagement are rare, particularly for YMSM and YTW, who typically prefer to receive care in multipurpose key population-focused community-based centers, which often lack evidence-driven, youth-specific interventions that include psychosocial and medication adherence support for best outcomes. This preference for key population-focused community centers is rational given the country’s unfavorable social milieu which promotes social stigma, lack of disclosure, and low social support, and in the context of a legal environment which criminalizes same-sex relationships. Evidence-based and scalable approaches, incorporating preferences for community centers, are needed to have the greatest impact on ART outcomes among YMSM and YTW in Nigeria. Thus, we propose to adapt and test the Intensive Combination Approach to Rollback the Epidemic in Nigeria (iCARE Nigeria), to improve HIV treatment engagement, medication adherence, and viral suppression among YMSM and YTW where they receive care. The iCARE Nigeria model uses evidence-based and youth-specific approaches, including peer navigation and daily text message reminders in combination. iCARE Nigeria has demonstrated efficacy in a general population of youth with HIV in a traditional HIV clinic at the University of Ibadan, Nigeria. In this study, we will expand it to YMSM and YTW cared for in community centers using a community and outreach-based delivery approach. Our goal is to develop a practical and scalable enhancement to HIV treatment for YMSM and YTW where they receive care. Our aims are to: 1) adapt the iCARE Nigeria HIV clinic-based intervention to a community-based outreach approach for YMSM and YTW ages 15-24 living with HIV in Ibadan, Nigeria; 2) test the adapted iCARE intervention for initial efficacy, feasibility, satisfaction, and acceptability among YMSM and YTW and 3) evaluate implementation indicators based on RE-AIM (reach, adoption, implementation, maintenance) to inform widespread dissemination and scalability of the adapted iCARE Nigeria intervention.