Improving Retention in Care for Adolescents and Young Adults in Kenya: Implementation Science to Support Adaptation and Integration of a Stepped Care Intervention

摘要 全世界有500万青少年和青壮年(Aya)感染艾滋病毒。全球90%以上的艾滋病毒- 在撒哈拉以南非洲发生了与阿亚病毒相关的死亡。有限但不断增长的干预证据基础 为撒哈拉以南非洲的青少年提供的服务强调了留住关爱以改善状况的重要性 治疗结果。与Aya会面，了解他们参与医疗保健系统、干预措施的情况 需要是可行的、可接受的和适合当地医疗保健设置和实践的。这个F31项目 利用整群随机对照试验、数据知情的分步护理改善青少年艾滋病毒 结果(UG3/UH3 HD096906；PI：Kohler，John-Stewart)正在测试分级护理干预措施 改善肯尼亚西部艾滋病毒携带者青少年和青壮年的滞留率。这个F31项目旨在 评估分步护理干预措施的早期实施结果，因为它在10个国家实施 医疗设施。目标1将确定对干预措施(材料、程序或交付)的适应 影响可接受性、可行性和适当性的因素。报告改编框架和 对循证干预措施(框架)的修改将被用来描述适应和 针对特定设施的干预措施优化所需的修改。目标2将确定障碍和 影响分级护理干预的渗透率、覆盖率和保真度的促进者。我们将应用 执行研究综合框架(CFIR)，以审查障碍和促进者 执行以了解影响执行的背景和干预特征 阶梯式护理干预。最后，目标3将把成功实施的障碍与有针对性的战略相匹配 为了克服这些问题，制定了一揽子干预实施方案，以促进长期 干预、采用和可持续性。该项目的发现将有助于理解优化 并提供有关成功纵向扩展所需环境的有价值的信息 针对肯尼亚境内青少年和青壮年的分步护理干预措施或扩展到其他全球环境。 该研究计划将为F31候选人，一名实施科学博士前学生，提供严格的 (1)实施科学概念框架、模型、设计和方法方面的培训；(2) 定性方法；以及(3)关于青少年循证干预的内容领域专门知识和 感染艾滋病毒的年轻人。

Abstract Worldwide, five million adolescents and young adults (AYA) are living with HIV. More than 90% of global HIV- related mortality among AYA occurs in sub-Saharan Africa. A limited but growing evidence base of interventions available for adolescents in sub-Saharan Africa highlight the importance of retention in care for improving treatment outcomes. To meet AYA where they are in their engagement with the healthcare system, interventions need to be feasible, acceptable, and appropriate for local healthcare settings and practice. This F31 project leverages a cluster randomized controlled trial, Data-informed Stepped Care to Improve Adolescent HIV Outcomes (UG3/UH3 HD096906; PIs: Kohler, John-Stewart) that is testing a Stepped Care intervention to improve retention among adolescents and young adults living with HIV in western Kenya. This F31 project aims to evaluate early phase implementation outcomes of the Stepped Care intervention as it is delivered across 10 healthcare facilities. Aim 1 will identify adaptations made to the intervention (materials, procedures, or delivery) that influence acceptability, feasibility, and appropriateness. The Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) will be used to characterize adaptations and modifications necessary for facility-specific optimization of the intervention. Aim 2 will identify the barriers and facilitators that impact penetration, coverage, and fidelity of the Stepped Care intervention. We will apply the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators of implementation to understand the context and intervention characteristics influencing implementation of the Stepped Care intervention. Finally, Aim 3 will match barriers to successful implementation to targeted strategies to overcome them, producing a package of intervention implementation options that promote long-term intervention adoption and sustainability. Findings from this project will contribute to understanding optimization of Stepped Care and provide valuable information about the context necessary for successful scale-up of Stepped Care interventions for adolescents and young adults within Kenya or scale out to other global settings. The research plan will provide the F31 candidate, an implementation science pre-doctoral student, with rigorous training in (1) implementation science conceptual frameworks, models, design and methodology; (2) training in qualitative methods; and (3) content-area expertise regarding evidence-based interventions for adolescents and young adults living with HIV.