Developing/Testing a Multi-level Interventions (SHIELD & IWC)

项目摘要/摘要 赞比亚是世界上艾滋病毒感染率最高的国家之一，少女和年轻妇女 (AGYW)受到的影响尤其大。先前的研究和倡议试图提供对青年友好的服务 通过提供一系列服务的青少年抗逆转录病毒疗法(ART)诊所，但这些诊所 面临挑战，因为失去隐私和与艾滋病毒相关的耻辱。为了解决这一差距， 赞比亚卫生部、国际RTI、人口理事会和北卡罗来纳大学 正在合作创建面向所有受艾滋病毒影响的综合健康护理(IWC)交付模式 AGYW，无论是艾滋病毒阴性或不知道自己状况的人(艾滋病毒-/U)还是艾滋病毒阳性的人 (HIV+)。我们将测试一套多层次的干预措施，将AGYW与常规护理来源联系起来 为成功实施定期艾滋病毒检测提供可持续的平台，并支持与 护理、护理中的保留和坚持抗病毒治疗。我们建议达致以下目标： UG3-1.通过建立社区和青年咨询委员会吸引利益攸关方参与，开展 研究、调整用于行为干预的模块，并开发数据收集工具。 UG3-2.招募AGYW建立抽样框架并进行离散选择实验 系统地评估对艾滋病毒诊所服务的偏好(10至20岁的1,000名艾滋病毒/u青年儿童 和800名16至24岁的HIV+AGYW)，以确保IWC诊所符合AGYW的需求。 UG3-3.制定IWC诊所服务交付和结构的标准操作程序(SOP)，确定 和培训IWC诊所工作人员，邀请青年咨询委员会创造一个有利于青年的环境，以及 开展一项试验性研究，以评估执行进程(25 AGYW)。 UH3-1.在个人进行多水平干预的6个月和12个月时评估有效性(艾滋病毒知识， (自我效能)、人际(社会支持、减少耻辱)和卫生系统(IWC诊所)的艾滋病毒水平 使用群集式随机设计进行测试、保留护理和病毒负载抑制。 UH3-2.对12个月大的临床工作人员和同行导航员进行深入访谈，以获得反馈 关于综合护理提供模式，以评估可持续性、记录最佳实践并更新SOP以 支持扩大AGYW综合服务规模。 UH3-3.进行成本效益和预算分析，以评估和描述艾滋病毒护理的影响 继续向国家合作伙伴和国际社会传播调查结果。 这种集成服务交付模式如果成功，还可以作为实施其他 预防性服务，包括暴露前预防(PrEP)，用于高危AGYW，目前正在 由政府考虑。

PROJECT SUMMARY/ABSTRACT Zambia has one of the highest incidences of HIV in the world, and adolescent girls and young women (AGYW) are particularly affected. Prior studies and initiatives attempted to provide youth-friendly services through adolescent antiretroviral therapy (ART) clinics that offer a range of services, but these clinics have faced challenges because loss of privacy and the stigma associated with HIV. To address this gap, the Zambian Ministry of Health, RTI International, the Population Council, and the University of North Carolina are collaborating to create an integrated wellness care (IWC) delivery model that targets all HIV-affected AGYW, both those that are HIV negative or do not know their status (HIV-/u) and those that are HIV positive (HIV+). We will test a multilevel package of interventions to connect AGYW with a source of regular care to provide a sustainable platform for successful implementation of regular HIV testing and support for linkage to care, retention in care, and adherence to antiviral treatment. We propose to pursue the following aims: UG3–1. Engage stakeholders by establishing community and youth advisory boards, conduct formative research, adapt modules for behavioral intervention, and develop data collection instruments. UG3–2. Recruit AGYW to establish a sampling frame and perform a discrete choice experiment to systematically evaluate preferences for HIV clinic-based services (1,000 HIV-/u AGYW aged 10 to 20 years and 800 HIV+ AGYW aged 16 to 24 years) to ensure the IWC clinic is tailored to AGYW's needs. UG3–3. Develop standard operating procedures (SOPs) for IWC clinic service delivery and structure, identify and train IWC clinic staff, engage the Youth Advisory Board to create a youth-friendly environment, and conduct a pilot study to evaluate implementation processes (25 AGYW). UH3–1. Assess efficacy at 6 and 12 months of the multilevel interventions at the individual (HIV knowledge, self-efficacy), interpersonal (social support, stigma reduction), and health system (IWC clinic) levels on HIV testing, retention in care, and viral load suppression using a cluster randomized design. UH3–2. Conduct in-depth interviews with clinical staff and peer navigators at 12 months to obtain feedback on the integrated care delivery model to assess sustainability, document best practices, and update SOPs to support scaling up of integrated services for AGYW. UH3–3. Perform cost-effectiveness and budget analysis to evaluate and describe impact along the HIV care continuum and disseminate findings to national partners and the international community. This integrated service delivery model, if successful, can also serve as a platform to implement additional preventive services, including pre-exposure prophylaxis (PrEP) for high-risk AGYW, which is currently under consideration by the government.