Self-Management among adolescents living with HIV in Uganda

项目摘要/摘要 乌干达有超过73,000名青少年携带艾滋病毒(ALHIV)，占全球艾滋病毒携带者的4% ALHIV的人口。艾滋病毒仍然是青少年死亡的主要原因，尽管艾滋病毒在青少年中广泛存在 抗逆转录病毒药物。一般来说，ALHIV的预后很差，有更高的失败率需要随访 与其他年龄段相比。在过渡期间，死亡率和失去后续行动的人数最多。 对于那些准备更好地在成人艾滋病毒诊所谈判护理的ALHIV患者来说，过渡的成功可能是最大的 设置。这种准备可以包括技能培训，以提高自我效能感、韧性和教育 解决缺乏艾滋病毒知识的问题，这两个问题都预示着过渡后会有更好的结果。规定 心理社会支持和成人艾滋病毒护理服务的准备信息也得到了 与成功过渡相关。建议的K43应用程序的总体目标是补充我的 精神病学的临床背景，有高级课程和行为科学方面的重点指导 开发和测试行为干预措施，以改善护理过渡。这次培训将使我能够 为了实现我的科学目标：开发和测试ALHIV过渡的自我管理干预 成人艾滋病毒护理。这次培训将使我能够实现我的科学目标：发展和测试自我 ALHIV的管理干预。此应用程序建议为以下对象开发自我管理干预 ALHIV过渡到成人艾滋病毒护理，并测试干预对艾滋病毒结果的影响。进行 这项申请中提议的研究将补充我之前的精神病学培训，同时填补在 三个领域：(A)行为科学理论及其在行为干预方面的应用；(B)适应和 设计行为干预措施，以及(C)通过随机试验测试行为干预措施。填满 对于这些差距，我将进行定性研究，阐述一个概念性的框架，即面临的障碍 在乌干达向成人艾滋病毒护理过渡(目标1)，制定自我管理干预措施，将 使ALHIV成功过渡到成人HIV护理(目标2)，并评估可行性、可接受性和 自我管理干预对ALHIV向成人过渡的HIV结局的初步影响 关爱(目标3)。这项研究将是第一次开发针对危重病患者的自我管理干预 撒哈拉以南非洲从儿童艾滋病毒护理到成人艾滋病毒护理的过渡期，并首次使用随机 旨在测试自我管理干预对乌干达ALHIV人群健康结局的影响 正在过渡到成人艾滋病毒护理。这些发现将通过优化健康对公共健康产生重大影响 全球艾滋病毒流行中的一个关键人群的结果。拟议的研究将作为一项 竞争性R01拨款提案，于第4年提交，用于进行完全有效的随机对照试验，以 评估行为干预改善护理保留率和病毒抑制的有效性 在乌干达正处于向成人艾滋病毒护理过渡的关键时期的艾滋病毒感染者中。

PROJECT SUMMARY/ABSTRACT There are over 73,000 adolescents living with HIV (ALHIV) in Uganda constituting 4% of the worldwide population of ALHIV. HIV remains a leading cause of death among adolescents despite widespread availability of antiretroviral medication. Generally, ALHIV have poor outcomes with higher rates of loss to follow up compared with other age groups. Mortality rates and loss to follow up are highest during the transition period. Transition success may be maximized for ALHIV who are better prepared to negotiate care in adult HIV clinic settings. This preparation can include skills training to improve self-efficacy, resilience, and education to address lack of HIV knowledge, both of which are predictive of better outcomes following transition. Provision of psychosocial support and preparatory information to navigate adult HIV care services have also been associated with successful transition. The overall goal of the proposed K43 application is to complement my clinical background in psychiatry with advanced coursework and focused mentoring in behavioral science and development and testing of behavioral interventions to improve transition in care. This training will enable me to achieve my scientific objective: to develop and test a self-management intervention for ALHIV transitioning to adult HIV care. This training will enable me to achieve my scientific objective: to develop and test a self- management intervention for ALHIV. This application proposes to develop a self-management intervention for ALHIV transitioning to adult HIV care and test the impacts of the intervention on HIV outcomes. Conducting the proposed studies in this application will complement my prior training in psychiatry while filling key gaps in three areas: (a) behavioral science theories and their application to behavioral interventions, (b) adaptation and design of behavioral interventions, and (c) testing of behavioral interventions through randomized trials. To fill these gaps, I will conduct qualitative research to elaborate a conceptual framework of the barriers faced by ALHIV transitioning to adult HIV care in Uganda (Aim 1), develop a self-management intervention that will enable ALHIV to successfully transition to adult HIV care (Aim 2), and assess feasibility, acceptability, and preliminary effects of the self-management intervention on HIV outcomes for ALHIV transitioning to adult HIV care (Aim 3). This study will be the first to develop a self-management intervention targeting the critical transition period from pediatric to adult HIV care in sub-Saharan Africa and the first to use a randomized design to test the effect of a self-management intervention on health outcomes among ALHIV in Uganda who are transitioning to adult HIV care. These findings will have significant public health impact by optimizing health outcomes for a key population in the global HIV epidemic. The proposed research will serve as the basis for a competitive R01 grant proposal, submitted in year 4, to conduct a fully-powered, randomized controlled trial to evaluate the effectiveness of a behavioral intervention to improve retention in care and viral suppression among ALHIV in Uganda who are navigating the critical period of transition to adult HIV care.