Implementation Research to Optimize ART Delivery for Adolescent Girls and Young Women Living with HIV in Tanzania

项目总结 这个为期五年的K01指导研究科学家发展奖将为Rucinski博士提供 指导和培训，成为一名独立的研究员，专注于优化健康的研究 以及撒哈拉以南非洲艾滋病毒感染和传播高风险的妇女和女孩的福祉。培训 是这项计划的基础，包括与专家和多学科的指导 实施科学(IS)研究人员、教学课程、体验式学习、与KEY的会议 艾滋病毒和 利益相关者和社区领袖，以及严格的指导性研究。以下培训目标将是 在该奖项期间完成：(1)在所使用的概念、理论、工具和方法方面获得科学专业知识 推进与艾滋病毒相关的研究和实践；(2)培养定性研究的综合技能 支持艾滋病毒相关信息系统研究采用混合方法的方法；以及(3)获取 青少年健康和发展方面的内容专业知识，为裁剪、适应和测试提供信息 为青少年和青壮年提供适合发展的性健康和生殖健康服务。 在这些目标的支持下，拟议的指导性研究项目 将生成一个定制的打包的 加强因地制宜的抗逆转录病毒疗法(ART)计划的实施战略 达累斯萨拉姆15-24岁感染艾滋病毒的少女和年轻妇女。在坦桑尼亚，四分之一 在所有每年新增的艾滋病毒感染病例中，AGYW是其中之一。尽管努力减少事件感染，但人数 在南部和东部非洲，AGYW艾滋病毒携带者的人数继续上升，而且越来越多地，负担是 那些性感染艾滋病毒的人 。此外，坦桑尼亚13万艾滋病毒携带者中有一半以上是 病毒不受抑制，增加了艾滋病毒进一步传播、发病率和死亡率的风险。几乎没有证据- 为改善青少年的保育和病毒抑制而采取的干预措施甚至更少 已经规模化实施。被称为“青少年俱乐部”的同伴支持模式已经被PEPFAR列为优先事项 以及坦桑尼亚政府的支持，以扩大规模。然而，有证据支持该方案的可行性、可接受性和 这种干预的效果好坏参半，需要进行实施研究，以接近以下证据 练习差距。以社区为导向的实施规划框架和综合 实施研究框架(CFIR)，我们在达累斯萨拉姆提出以下目标：(1) 检查与保留护理和HIV病毒相关的社会、结构和临床层面的因素 参加梦想预防计划的AGYW新感染者或 被诊断出感染艾滋病毒；(2)完善一套量身定做的实施战略，以优化同伴支持模式 用于艾滋病毒治疗；以及(3)试点量身定做的一揽子方案的可行性、可接受性和初步有效性 关于艾滋病病毒携带者青年儿童的实施战略。调查结果将为R01-Level奠定基础 随机混合有效性试验，将促进鲁辛斯基博士向独立的过渡。

PROJECT SUMMARY This five-year K01 Mentored Research Scientist Development Award will provide Dr. Rucinski with the mentorship and training to become an independent investigator focused on research that optimizes the health and well-being of women and girls at high risk of HIV acquisition and transmission in sub-Saharan Africa. Training is at the foundation of this proposal and comprises mentorship with expert and multi-disciplinary implementation science (IS) researchers, didactic coursework, experiential learning, meetings with key HIV and stakeholders and community leaders, and rigorous mentored research. The following training objectives will be accomplished during this award: (1) Obtain scientific expertise in the concepts, theories, tools and methods used to advance HIV-related IS research and practice; (2) Develop comprehensive skills in qualitative research methods to support the application of mixed-methods approaches for HIV-related IS research; and (3) Acquire content expertise in adolescent health and development to inform the tailoring, adaptation, and testing of developmentally appropriate sexual and reproductive health services for adolescents and young adults. Supported by these objectives, the proposed mentored research project will generate a tailored packaged of implementation strategies to strengthen contextually appropriate antiretroviral therapy (ART) programs for adolescent girls and young women (AGYW) aged 15-24 living with HIV in Dar es Salaam. In Tanzania, a quarter of all new annual HIV infections are among AGYW. Despite efforts to decrease incident infections, the number of AGYW living with HIV in southern and eastern Africa continues to rise and increasingly, the burden is among those with sexually acquired HIV . Further, more than half of the 130,000 AGYW living with HIV in Tanzania are virally unsuppressed, increasing their risk for onward HIV transmission, morbidity, and mortality. Few evidence- based interventions exist to improve retention in care and viral suppression for adolescents, and even fewer have been implemented at scale. Peer support models known as “teen clubs” have been prioritized by PEPFAR and the Government of Tanzania for scale up. Yet evidence to support the feasibility, acceptability, and effectiveness of this intervention is mixed, and implementation research is needed to close the evidence to practice gap. Guided by a community-driven implementation planning framework and the Consolidated Framework for Implementation Research (CFIR), we propose the following aims in Dar es Salaam: (1) Examine the social, structural, and clinic-level factors associated with retention in care and HIV viral suppression among AGYW participating in the DREAMS prevention program who were newly infected or diagnosed with HIV; (2) Refine a tailored package of implementation strategies to optimize a peer-support model for HIV treatment; and (3) Pilot the feasibility, acceptability, and preliminary effectiveness of a tailored package of implementation strategies for AGYW living with HIV. Findings will form the foundation for a R01-level randomized hybrid effectiveness trial and will facilitate Dr. Rucinski’s transition to independence.