Examining family and household factors related to HIV self-management among adolescents and young adults living with HIV in Ndola, Zambia

项目总结 背景资料。为了到2030年结束艾滋病的流行，青少年和年轻人的健康需求 (Aya)必须满足15至24岁艾滋病毒携带者的要求。抗逆转录病毒治疗的依从性是最 在这一人群中达到预期健康结果的显著障碍。理解和参与家庭和 家庭层面是艾滋病毒携带者阿雅实现病毒抑制的当务之急。 学习目标和目的。这项研究的目的是更好地了解家庭和家庭层面的因素 与赞比亚恩多拉艾滋病毒携带者的艾滋病毒自我管理有关并对其产生影响。具体的 这项研究的目的是：(1)定性地了解正在过渡到Aya的护理人员的经历 艾滋病毒自我管理。(2)定量评估阿雅感知的家庭连通性是如何关联的 在艾滋病毒自我管理的背景下抑制病毒。(3)定性探索可修改的家庭和 家庭层面对艾滋病病毒自我管理的影响。这项工作符合NIMH高度优先的领域 推动制定超越个人层面的干预措施，并改进艾滋病毒治疗 通过最佳的治疗依从性和持续的护理投入取得的成果。 接近。这项说明性的顺序混合方法研究将利用 完成的父母研究，一项个人随机对照试验，评估了6个月的同龄人- 年通过护理者支持部分对Aya艾滋病毒携带者的HIV结局进行指导干预 恩多拉，赞比亚。目标1和目标2是对定性和定量父母研究数据的二次分析， 分别进行了分析。目标1将是对深度访谈(IDI)进行归纳和演绎的主题定性分析 来自23名Aya参与者的照顾者。Aim 2将使用以下基线数据开发结构方程模型 来自父母研究的260名艾滋病毒阳性的AYA参与者；这将量化和解释 家庭关系和病毒抑制。目标3将需要主要的定性数据收集；最多两个新的国际开发计划署 将与大约20名AYA家长研究参与者和照顾者夫妇一起进行。这些人 访谈将以目标1和目标2的调查结果为基础，并将使用类似于目标的主题方法进行分析 1.将对AIMS 1-3的调查结果进行三角划分，以便对这一重要议题有更细微的了解。 团契信息。这项拟议的研究将作为柯斯蒂·西夫赖特女士的博士论文， 约翰霍普金斯大学彭博公共卫生学院的博士生。培训由一位赞助商指导， 三名共同赞助者和一名科学顾问，在主题、理论和方法方面相互补充 专业知识，包括对感染艾滋病毒的阿亚的研究。培训计划结合了正在进行的正式课程 指导、实地研究和其他机会，帮助西夫赖特女士成为一名领先的独立人士 社会和行为科学研究人员，重点研究阿亚的艾滋病毒预防、护理和治疗。

PROJECT SUMMARY Background. In order to end the AIDS epidemic by 2030, the health needs of adolescents and young people (AYA) aged 15 to 24 years living with HIV must be met. Antiretroviral therapy adherence is one of the most notable barriers to desired health outcomes in this population. Understanding and engaging the family and household level is imperative for AYA living with HIV to achieve viral suppression. Study Goal and Aims. The goal of this study is to better understand how family and household level factors relate to and influence the self-management of HIV among AYA living with HIV in Ndola, Zambia. The specific aims of this study are: (1) To qualitatively understand caregiver experiences with AYA who are transitioning to HIV self-management. (2) To quantitatively assess how AYA’s perceived family connectedness is associated with viral suppression in the context of HIV self-management. (3) To qualitatively explore modifiable family and household level influences on AYA self-management of HIV. This work is in line with NIMH high priority areas to advance the development of interventions delivered beyond the individual level and to improve HIV treatment outcomes through optimal treatment adherence and sustained engagement in care. Approach. This explanatory, sequential mixed-methods study will leverage the data and infrastructure of a completed parent study, an individually-randomized controlled trial that assessed the impact of a 6-month peer- mentoring intervention with a caregiver support component on HIV outcomes among AYA living with HIV in Ndola, Zambia. Aims 1 and 2 are secondary analyses of qualitative and quantitative parent study data, respectively. Aim 1 will be an inductive and deductive thematic qualitative analysis of in-depth interviews (IDIs) from 23 caregivers of AYA participants. Aim 2 will develop a structural equation model using baseline data from 260 HIV-positive AYA participants from the parent study; this will quantify and explain associations between family connection and viral suppression. Aim 3 will require primary qualitative data collection; up to two new IDIs will be conducted with approximately 20 AYA parent study participant and caregiver dyads. These individual interviews will build upon findings from Aims 1 and 2 and will be analyzed using a thematic approach akin to Aim 1. Findings from Aims 1-3 will be triangulated to develop a more nuanced understanding of this important topic. Fellowship Information. The proposed research will serve as the doctoral dissertation of Ms. Kirsty Sievwright, a PhD student at Johns Hopkins Bloomberg School of Public Health. The training is guided by one Sponsor, three Co-Sponsors, and one Scientific Advisor with complementary topical, theoretical, and methodological expertise, including in research with AYA living with HIV. The training plan combines formal coursework, ongoing mentorship, field research, and other opportunities to prepare Ms. Sievwright to become a leading independent researcher in the social and behavioral sciences, focused on HIV prevention, care, and treatment among AYA.