The Adolescent to Adult Patient-centered HIV Transition Study (ADAPT)

新兴的艾滋病毒携带者面临的一个明显挑战是，他们的护理从长期的 儿童艾滋病毒提供者在成人艾滋病毒计划内接受治疗。虽然从概念上讲，从 从儿科到成人的护理看似简单，但现实情况是，过渡往往是非常困难的 进程。转型不成功的后果可能从困难到灾难性。这个 青少年到成人以患者为中心的HIV过渡(Adapt)研究是一项创新的随机试验 针对护理差距的干预措施是造成ART连续护理损失的主要原因，这些干预措施包括 青少年和越来越多的人错失了让青少年参与照料的机会。的具体目标 适应是：(A)在资源有限的情况下为过渡服务战略提供信息；(B)审查 预测成功过渡的发育、临床和其他因素；以及(C)获得基本的 通过自我网络的应用洞察非洲青少年的执行障碍 明确的社会支持，将为结构化干预的目标提供信息。我们的多元PI团队包括强大的 在儿科和青少年艾滋病毒护理、流行病学和社会科学方面的互补专业知识。适应意志 将在尼日利亚中部、南部和北部的选定的PEPFAR地点进行，地点由 尼日利亚，人类病毒学。为了实现目标1，我们将开展六个焦点小组，包括：青少年患者， 父母和医疗保健提供者。为了解决目标2，我们将进行一项整群随机临床试验。这个 有两种干预措施基于先前的循证参与战略：1)教育干预 2)使用同伴转变倡导者的干预措施，该倡导者为青少年及其父母做好准备 过渡。我们将招募300名患者(每支手臂150名患者)。这些地点将被随机分配到一个 干预。主要结果将是成功过渡，将两次后续任命保持在 过渡期后九个月。焦点小组参与者建议的次要结果 也将被测量。研究社交网络组件的潜在作用以及两者的特征 自我和改变对主要结果的影响，将使用广义估计方程(GEE)方法 在自我、改变和网络层面上探索主要结果和因素之间的联系。这个 这项研究的发现将指导尼日利亚和其他地区过渡青少年的最佳实践机构 低收入国家和中等收入国家面临类似挑战，并有可能产生较大影响。

One of the distinct challenges faced by emerging adults with HIV is the transition of their care from their long- term pediatric HIV provider to treatment within an adult HIV program. While conceptually the transition from pediatric to adult care may seem straightforward, the reality is that the transition often is a very difficult process. The consequences of an unsuccessful transition can range from difficult to catastrophic. The Adolescent to Adult Patient-centered HIV Transition (ADAPT) Study is a randomized trial of innovative interventions targeting gaps in care that are major drivers of loss in the ART continuum of care cascade among adolescents and increasing missed opportunities to engage adolescents into care. The specific aims of ADAPT are: (a) to inform strategies for transition services in resource-limited settings; (b) to examine the developmental, clinical, and other factors that predict a successful transition; and (c) to gain fundamental insight on implementation barriers among African adolescents through the application of the ego-network defined social support that will inform targets for structured intervention. Our multi-PI team includes strong complementary expertise in pediatric and adolescent HIV care, epidemiology, and social science. ADAPT will be conducted in central, southern, and northern Nigeria at selected PEPFAR sites supported by the Institute of Human Virology, Nigeria. To address Aim 1 we will conduct six focus groups including: Adolescent patients, parents and health care providers. To address aim 2, we will conduct a cluster randomized clinical trial. The two interventions are based on prior evidence-informed engagement strategies: 1) educational interventions and 2) interventions that use a peer transition advocate who prepares the adolescent and their parents for transition. We will enroll 300 patients (150 patients in each arm). The sites will be randomized to an intervention. The primary outcome will be successful transition, keeping two follow-up appointments within a nine months period following transition. Secondary outcomes, as recommended by focus group participants will also be measured. To examine the potential role of social network components and characteristics of both egos and alters on primary outcomes, a Generalized Estimating Equation (GEE) approach will be used to explore the associations between primary outcomes and factors at the ego, alter, and network levels. The finding from this study will guide institution of best practices for transitioning adolescents in Nigeria and other countries lower and middle income countries with similar challenges and potential for high impact.