Examining family and household factors related to HIV self-management among adolescents and young adults living with HIV in Ndola, Zambia

项目摘要 背景为了到2030年结束艾滋病流行，青少年和年轻人的健康需求 (AYA)15至24岁的艾滋病毒感染者必须满足。抗逆转录病毒治疗依从性是最重要的 在这一人群中实现预期健康结果的显著障碍。理解和参与家庭， 家庭一级是艾滋病毒感染者AYA实现病毒抑制的必要条件。 研究目的和目标。这项研究的目的是更好地了解家庭和家庭层面的因素是如何 与赞比亚恩多拉艾滋病毒感染者中的艾滋病毒自我管理有关并影响艾滋病毒自我管理。具体 本研究的目的是：（1）定性地了解AYA过渡期照顾者的经验， 艾滋病毒自我管理。(2)定量评估AYA感知的家庭连通性如何与 在HIV自我管理的背景下进行病毒抑制。(3)定性地探讨可修改的族和 家庭水平对AYA艾滋病自我管理的影响。这项工作符合NIMH的高度优先领域， 推动制定超越个人层面的干预措施，并改善艾滋病毒治疗 通过最佳的治疗依从性和持续的护理参与来取得成果。 Approach.这种解释性的、连续的混合方法研究将利用一个 完成的父母研究，一项单独随机对照试验，评估了6个月的同龄人的影响， 在艾滋病毒感染者中开展辅导干预，包括照顾者支持部分， 赞比亚，恩多拉。目的1和2是定性和定量母研究数据的次要分析， 分别目标1是对深度访谈进行归纳和演绎的主题定性分析 来自23名AYA参与者的照顾者。Aim 2将使用以下基线数据开发结构方程模型： 来自母研究的260名HIV阳性AYA参与者;这将量化并解释 家庭联系和病毒抑制目标3将要求收集基本的定性数据;最多两个新的IDI 将在大约20名AYA父母研究参与者和护理人员配对中进行。这些单独 访谈将建立在目标1和2的调查结果基础上，并将使用类似于目标的主题方法进行分析 1.将对目标1-3的调查结果进行三角分析，以更细致地了解这一重要主题。 奖学金信息。拟议的研究将作为Kirsty Sievwright女士， 约翰霍普金斯布隆伯格公共卫生学院的博士生。培训由一个赞助商指导， 三个共同赞助商和一个科学顾问与互补的主题，理论和方法 专业知识，包括对艾滋病毒感染者的研究。培训计划结合了正式的课程，持续的 导师，实地研究和其他机会，准备女士Sievwright成为一个领先的独立 社会和行为科学研究员，专注于艾滋病毒的预防，护理和AYA治疗。

PROJECT SUMMARY Background. In order to end the AIDS epidemic by 2030, the health needs of adolescents and young people (AYA) aged 15 to 24 years living with HIV must be met. Antiretroviral therapy adherence is one of the most notable barriers to desired health outcomes in this population. Understanding and engaging the family and household level is imperative for AYA living with HIV to achieve viral suppression. Study Goal and Aims. The goal of this study is to better understand how family and household level factors relate to and influence the self-management of HIV among AYA living with HIV in Ndola, Zambia. The specific aims of this study are: (1) To qualitatively understand caregiver experiences with AYA who are transitioning to HIV self-management. (2) To quantitatively assess how AYA’s perceived family connectedness is associated with viral suppression in the context of HIV self-management. (3) To qualitatively explore modifiable family and household level influences on AYA self-management of HIV. This work is in line with NIMH high priority areas to advance the development of interventions delivered beyond the individual level and to improve HIV treatment outcomes through optimal treatment adherence and sustained engagement in care. Approach. This explanatory, sequential mixed-methods study will leverage the data and infrastructure of a completed parent study, an individually-randomized controlled trial that assessed the impact of a 6-month peer- mentoring intervention with a caregiver support component on HIV outcomes among AYA living with HIV in Ndola, Zambia. Aims 1 and 2 are secondary analyses of qualitative and quantitative parent study data, respectively. Aim 1 will be an inductive and deductive thematic qualitative analysis of in-depth interviews (IDIs) from 23 caregivers of AYA participants. Aim 2 will develop a structural equation model using baseline data from 260 HIV-positive AYA participants from the parent study; this will quantify and explain associations between family connection and viral suppression. Aim 3 will require primary qualitative data collection; up to two new IDIs will be conducted with approximately 20 AYA parent study participant and caregiver dyads. These individual interviews will build upon findings from Aims 1 and 2 and will be analyzed using a thematic approach akin to Aim 1. Findings from Aims 1-3 will be triangulated to develop a more nuanced understanding of this important topic. Fellowship Information. The proposed research will serve as the doctoral dissertation of Ms. Kirsty Sievwright, a PhD student at Johns Hopkins Bloomberg School of Public Health. The training is guided by one Sponsor, three Co-Sponsors, and one Scientific Advisor with complementary topical, theoretical, and methodological expertise, including in research with AYA living with HIV. The training plan combines formal coursework, ongoing mentorship, field research, and other opportunities to prepare Ms. Sievwright to become a leading independent researcher in the social and behavioral sciences, focused on HIV prevention, care, and treatment among AYA.