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 尼日利亚是占全球青年艾滋病毒携带者负担一半的六个国家之一。艾滋病病毒流行率在 与男性发生性关系的年轻男性(YMSM)和年龄在15-24岁之间的年轻变性女性(YTW)的比例超过6倍 这是对一般青年人口的影响。此外，在风险群体中，年轻人的情况更糟 与成人相比的艾滋病毒护理结果。在治疗参与和病毒感染方面存在挑战 YMSM和YTW之间的抑制。而成人艾滋病毒护理通常从15岁开始，适合年轻人 支持成功的护理投入的计划很少，特别是对于YMSM和YTW来说，他们通常 更愿意在多用途、以人口为重点的社区中心接受护理，而这些中心往往缺乏 循证、针对青年的干预措施，包括心理社会和服药依从性支持 最好的结果。这种对重点人口集中的社区中心的偏好是合理的，因为该国 不利的社会环境，助长社会耻辱、缺乏披露和低社会支持，以及在 将同性关系定为犯罪的法律环境的背景。基于证据且可扩展 需要结合对社区中心的偏好的方法，才能对艺术产生最大影响 尼日利亚基督教青年会和基督教青年会的结果。因此，我们建议调整和测试这种密集的组合 采取办法扭转尼日利亚(ICARE)的疫情，改善艾滋病毒治疗工作， YMSM和YTW之间的药物依从性和病毒抑制，他们在那里接受治疗。《冰河》 尼日利亚模式采用循证和针对青年的方法，包括同行导航和日常文本 消息提醒组合在一起。ICARE尼日利亚已在普通青年人群中显示出疗效 尼日利亚伊巴丹大学的一家传统艾滋病毒诊所发现了艾滋病毒携带者。在本研究中，我们将把它扩展到YMSM YTW在社区中心使用基于社区和外展的交付方法进行护理。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改进方案，在那里他们将获得 关心。我们的目标是：1)将以尼日利亚艾滋病诊所为基础的干预转变为以社区为基础的干预 针对尼日利亚伊巴丹15-24岁艾滋病毒携带者的基督教男同性恋者和青年妇女的外展方法；2)测试适应的 青年男性接触者和青年妇女的初步效果、可行性、满意度和可接受性的ICARE干预； 根据RE-AIM(覆盖、采用、实施、维护)评估实施指标，以 通报适应后的icare尼日利亚干预措施的广泛传播和可扩充性。

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.