Data-informed Stepped Care (DiSC) to Improve Adolescent HIV Outcomes

项目摘要/摘要 青少年(10-19岁)经历了不成比例的低保留率、抗逆转录病毒(ART)依从性和病毒 与其他年龄段的抑制率相比。在高流行率、资源有限的环境中开展艾滋病毒护理方案 开发了改进联系、保留和病毒抑制的创新方法，包括简化 治疗方案、任务转移和同伴支持。然而，明确的招生政策和做法 艾滋病毒服务和研究中的青少年，以及确定哪些青少年有需要的系统战略 缺乏更多的重症监护，以成功地实现艾滋病毒护理连续统一体上的关键里程碑。‘步入正轨 护理方法，其中风险最大的客户接受的护理强度和频率越来越高， 已被用于有针对性的干预和有效利用资源。一种使用标准化的临床预测工具 风险评分可以帮助医疗保健提供者识别有更大负面风险的青少年 结果和对结果的直接干预支持。我们以数据为基础的分级护理(DISC)干预对 使用临床预测工具进行分级护理，以优化有限的资源并改善艾滋病毒的护理和治疗 结果。我们的团队在肯尼亚的儿科和成人艾滋病毒项目中工作了20多年， 包括已建立的青少年艾滋病毒研究资料库，建议实施这一组合数据- 使用阶梯式护理模式进行驱动干预，为公共卫生决策提供信息并改善青少年 肯尼亚的艾滋病毒护理。UG3的形成工作将包括建立一个以临床为基础的潜在队列 肯尼亚西部6家数量庞大的艾滋病毒诊所，10-19岁的青少年和他们的照顾者。基于数据 从电子病历的调查和摘要中得出，我们将确定损失的关键预测因素 护理和疑似病毒学失败，并开发临床预测工具，以确定青少年需要更多 强化保障。我们将进行焦点小组和访谈，以了解和优化青少年的同意 以及对艾滋病毒护理和研究的代表性参与。这项工作，包括青少年和社区 利益攸关方的观点，将为青少年艾滋病毒预防盘式干预的发展和优化提供信息 UH3的治疗管理。DISC将通过20个大容量HIV的整群随机试验进行评估 诊所，观察有效性(6个月和12个月保留、病毒抑制、ART依从性)和 实施成果(可行性和可接受性)。这些目标有可能提供一个可概括的、 系统地提供差异化的青少年艾滋病毒护理，并与各种艾滋病毒护理计划相结合 以及现有的支持选择，以加快实现青少年90-90-90目标的进展。

PROJECT SUMMARY/ABSTRACT Adolescents (ages 10-19) experience disproportionately low retention, antiretroviral (ART) adherence and viral suppression compared to other age groups. HIV care programs in high prevalence, resource-limited settings have developed innovative approaches to improve linkage, retention and viral suppression, including simplified treatment regimens, task-shifting, and peer support. However, clear policies and practices for enrolling adolescents in HIV services and research, as well as systematic strategies that identify adolescents who need more intensive care to successfully achieve key milestones along the HIV care continuum, are lacking. ‘Stepped care’ approaches, where the most at-risk clients receive increasing levels of intensity and frequency of care, have been used to target interventions and efficiently use resources. A clinical prediction tool using standardized risk scores can help healthcare providers to identify adolescents at greater risk of experiencing negative outcomes and direct interventional support to them. Our data-informed stepped care (DiSC) intervention pairs stepped care with a clinical prediction tool to optimize limited resources and improve HIV care and treatment outcomes. Our team, which has worked with pediatric and adult HIV programs in Kenya for over two decades, including an established repertoire of adolescent HIV studies, proposes to implement this combination data- driven intervention using a stepped care model to inform public health decision-making and improve adolescent HIV care in Kenya. Formative work in UG3 will include establishment of a clinic-based prospect cohort of adolescents ages 10-19 and their care givers at 6 high volume HIV clinics in Western Kenya. Based on data derived from surveys and abstraction of electronic medical records, we will determine key predictors of loss to care and suspected virologic failure, and develop a clinical prediction tool to identify adolescents needing more intensive support. We will conduct focus groups and interviews to understand and optimize adolescent consent and representative participation in HIV care and research. This work, including adolescent and community stakeholder perspectives, will inform development and optimization of the DiSC intervention for adolescent HIV treatment management in UH3. DiSC will be evaluated through a cluster randomized trial at 20 high-volume HIV clinics, looking at both effectiveness (6 and 12-month retention, viral suppression, ART adherence) and implementation outcomes (feasibility and acceptability). These aims have potential to provide a generalizable, systematic approach to deliver differentiated adolescent HIV care that integrates with diverse HIV care programs and available support options to accelerate progress toward achieving the 90-90-90 targets for adolescents.