Adolescent Coordinated Transition (ACT) to Improve Health Outcomes among Nigerian HIV Youth

青少年协调过渡 (ACT) 旨在改善尼日利亚艾滋病毒青少年的健康状况

• 批准号: 9206425
• 负责人: Echezona Edozie Ezeanolue
• 金额: $ 30.61万
• 依托单位: UNIVERSITY OF NEVADA LAS VEGAS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-10 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9206425
• 关键词: 14 year old; 15 year old; AIDS prevention; Accounting; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent; Adolescent Health Services; Adolescent Medicine; Adult; Africa South of the Sahara; Age; Caring; Case Management; Cessation of life; Child; Childhood; Clinic; Clinic Visits; Clinical Research; Cluster randomized trial; Collaborations; Communication; Control Groups; Control Locus; Country; Epidemic; Evaluation; Family; Family health status; Fracture; Goals; HIV; HIV-infected adolescents; Health; Health Status; Health care facility; Health system; Healthcare; Human; Individual; Institutes; International; Intervention; Knowledge; Life; Literature; Measures; Mediation; Mental Health; Modeling; Nevada; Nigeria; Nigerian; Outcome; Patients; Policies; Preparation; Process; Protocols documentation; Provider; Quality of Care; Randomized; Research; Resources; Self Management; Support Groups; System; Testing; Training; UNICEF; Universities; Viral; Work; Youth; arm; base; clinical care; college; comparative effectiveness; design; evidence base; follow-up; group intervention; health care delivery; implementation science; improved; improved outcome; intervention program; member; mortality; pediatric human immunodeficiency virus; pediatrician; peer; primary outcome; programs; psychosocial; retention rate; secondary outcome; skills; standard of care; treatment as usual; trial design; virology

PROGRAM SUMMARY In 2013, AIDS was the leading cause of mortality among adolescents in sub-Saharan Africa (SSA). Research has shown that mortality among adolescents increases with transfer from pediatric to adult care due to poor retention in care, low viral suppression and poor psychosocial wellbeing. Majority of these deaths occurred in SSA. Few countries in SSA have an evidence-based protocol to transition ALHIV from pediatric to adult care. Nigeria has an estimated 160, 000 to 200,000 adolescents living with HIV (ALHIV), making it the country with the 2nd highest burden of HIV. In 2013, Nigeria accounted for ~10% of the deaths, with an estimated 11,000 AIDS-related deaths among adolescents. While previous national policy documents in Nigeria have recognized HIV among adolescents as an issue, none of these documents provide a comprehensive policy on ALHIV and none has any focus on transition of care. Nigeria is one of 25 target countries identified by the UNAIDS, UNICEF and partners in the “All in to End Adolescent AIDS” initiative. “All In” focuses on adolescents as part of the fast- track goals to end the HIV epidemic by 2030. The proposed research is designed to identify feasible, acceptable and sustainable approaches to transition ALHIV from pediatric to adult care. It is timely, as the Federal Ministry of Health and partners are working on finalizing a strategy for adolescents and young people living with HIV in Nigeria. Our proposed cluster randomized trial will test the comparative effectiveness of an Adolescent Coordinated Transition (ACT) program (Intervention Group; IG) versus the standard of care that abruptly transfers adolescents to adult care (Control Group, CG), on retention in care, viral suppression and psychosocial wellbeing among 216 HIV-infected Nigerian adolescents. Twelve healthcare facilities from all six geo-political zones will be randomly assigned (1:1) to IG or CG. ACT is a combination of a graduated transition program plus a pre-and post-transition peer-led Organized Support Group. The primary outcome is post-transition retention in care among ALHIV. Secondary outcomes are the difference among the groups in viral suppression rates and psychosocial wellbeing measured by improvement in perceived mental health status and the shift from external to internal health locus of control. This proposal is a collaboration among five members of the Nigeria Implementation Science Alliance (NISA) that currently serve nearly 25,000 ALHIV across all 36 states in Nigeria. NISA members have expertise in the implementation of nationally-supported programs for people living with HIV in Nigeria. Collaborators includes: Institute of Human Virology Nigeria; Family Health International 360, AIDS Prevention Initiative in Nigeria, Center for Clinical Care and Clinical Research Nigeria, and Center for Integrated Health Programmes (local program implementation and coordination); Nevada State College (statistical analyses and mediation/moderation analysis), and University of Nevada, Las Vegas (overall oversight of program implementation and evaluation).

计划概要 2013 年，艾滋病是撒哈拉以南非洲 (SSA) 青少年死亡的主要原因。研究 研究表明，由于贫困，青少年的死亡率随着从儿科护理转移到成人护理而增加 护理保留率低、病毒抑制率低和社会心理健康状况不佳。这些死亡大多数发生在 SSA。 SSA 中很少有国家拥有将 ALHIV 从儿科护理过渡到成人护理的循证方案。 尼日利亚估计有 160, 000 至 200,000 名青少年感染艾滋病毒 (ALHIV)，使其成为艾滋病毒感染率最高的国家 艾滋病毒的第二大负担。 2013 年，尼日利亚约占死亡人数的 10%，估计有 11,000 人 青少年中与艾滋病相关的死亡。虽然尼日利亚之前的国家政策文件已经承认 青少年中的艾滋病毒作为一个问题，这些文件都没有提供关于 ALHIV 和艾滋病毒的全面政策 没有人关注护理的过渡。尼日利亚是联合国艾滋病规划署、联合国儿童基金会确定的25个目标国家之一 以及“全力终结青少年艾滋病”倡议的合作伙伴。 “All In”重点关注青少年，作为快速发展的一部分 跟踪到 2030 年结束艾滋病毒流行的目标。拟议的研究旨在确定可行的、可接受的 将 ALHIV 从儿科护理过渡到成人护理的可持续方法。这是及时的，因为联邦部 卫生部门和合作伙伴正在努力最终确定一项针对感染艾滋病毒的青少年和年轻人的战略 尼日利亚。 我们提出的整群随机试验将测试青少年协调的比较有效性 过渡 (ACT) 计划（干预组；IG）与突然转移的护理标准 青少年到成人护理（对照组，CG），关于保留护理、病毒抑制和社会心理健康 216 名感染艾滋病毒的尼日利亚青少年中。来自所有六个地缘政治区的十二个医疗机构将 被随机分配（1：1）到IG或CG。 ACT 是毕业过渡课程加上预科和预科课程的组合 过渡后由同行领导的有组织的支持小组。主要结果是过渡后保留护理 ALHIV 中。次要结果是各组之间病毒抑制率和 社会心理健康通过感知心理健康状况的改善和外部环境的转变来衡量 内部健康控制点。该提案是尼日利亚五个成员之间的合作 实施科学联盟 (NISA) 目前为尼日利亚所有 36 个州的近 25,000 名 ALHIV 患者提供服务。 NISA 成员在实施国家支持的艾滋病毒感染者计划方面拥有专业知识 在尼日利亚。合作者包括：尼日利亚人类病毒学研究所；国际家庭健康 360，艾滋病 尼日利亚预防倡议、尼日利亚临床护理和临床研究中心以及综合中心 卫生计划（地方计划实施和协调）；内华达州立学院（统计 分析和调解/调节分析），以及内华达大学拉斯维加斯分校（总体监督 计划实施和评估）。