Suubi+Adherence-R2: Examining the longitudinal HIV treatment adherence among youth living with HIV (YLHIV) transitioning into young adulthood

项目摘要 Suubi+依从性研究（R 01 HD 074949）的竞争性更新将检查纵向HIV 抗逆转录病毒治疗（ART）的依从性和相关结果，以及保护性健康的潜在机制 参与循证家庭经济调查的艾滋病毒感染者（YLHIV）的行为 在乌干达，妇女参与了增强妇女权能（FEE）的干预措施，目前正过渡到青年期。撒哈拉以南非洲 (SSA)是世界上艾滋病感染率最高的国家在乌干达，一个贫穷的撒哈拉以南非洲国家艾滋病毒感染最严重， 青少年和年轻人（15至24岁）中病毒载量抑制的患病率为44.9%， 女性占32.5%，男性占32.5%。六年（2012-2018），Suubi+依从性研究前瞻性随访 702名YLHIV（入组时年龄为10至16岁）随机分配至乌干达39家诊所的两个研究组：1） 对照组由强化标准治疗（BSOC）组成，2）干预组由BSOC和 费干预。研究结果指出，上级短期病毒抑制和积极的儿童健康， 心理健康功能的干预臂。这次更新（Suubi+坚持第二轮）提出， 检查结果是否能维持到成年初期，这是一个非常脆弱的过渡期， 特别是在坚持艾滋病毒治疗、认知发展、心理健康、性风险承担等领域， 行为和酒精/药物滥用。更新（2020-2025）将建立在Suubi+Adherence研究的基础上， 进行一项最大和最长的研究YLHIV在SSA的发展期间， 通过深刻的生物和心理成熟，发展过渡里程碑。在下一 在这一阶段，我们还将增加一个定性部分，以检查参与者对FEE计划的体验 作为长期影响。创新地，我们还将评估FEE对认知功能的影响。研究 具体目标是：目标1。检查Suubi+依从性干预对以下方面的长期影响：HIV病毒 抑制（主要结局），并探讨干预措施对关键艾滋病毒治疗的长期影响 YLHIV的依从性结局，包括参与者获得和补充处方药物的能力，依从性 按照处方进行日常用药，并从事艾滋病毒护理;目标2.为了阐明的长期影响 Suubi+对潜在变化机制的依从性干预，包括：a）经济稳定，性风险- 采取行为，坚持自我效能; B）认知功能; c）心理健康功能;和d）年轻 成人过渡和社会支持;目标3。定性检查-前瞻性和回顾性：a）多- 自Suubi+依从性干预以来影响参与者维持干预获益的水平因素 启动（前瞻性）;和B）参与者的干预经验（回顾性），包括多个 可能影响他们参与计划和决策的因素 坚持抗逆转录病毒治疗;目标4。检查Suubi+依从性干预的长期成本效益。 这项研究与美国国立卫生研究院艾滋病研究办公室的优先事项保持一致。

PROJECT ABSTRACT This competing renewal to Suubi+Adherence study (R01HD074949) will examine the longitudinal HIV antiretroviral therapy (ART) adherence and related outcomes, and the potential mechanisms of protective health behaviors among youth living with HIV (YLHIV) who participated in an evidence-based family economic empowerment (FEE) intervention in Uganda and are now transitioning into young adulthood. Sub-Saharan Africa (SSA) has the highest HIV prevalence rate in the world. In Uganda, a poor SSA country hardest hit with HIV, the prevalence of viral load suppression among adolescents and young adults (15 to 24 years old) is 44.9% for females and 32.5% for males. For six years (2012-2018), the Suubi+Adherence study prospectively followed 702 YLHIV (aged 10 to 16 years at enrollment) randomized to two study arms across 39 clinics in Uganda: 1) control arm consisting of bolstered standard of care (BSOC) and 2) intervention arm consisting of BSOC and a FEE intervention. Study findings pointed to superior short-term viral suppression and positive child health and mental health functioning among the intervention arm. This renewal (Suubi+Adherence-Round 2) proposes to examine whether the results are maintained through young adulthood, an incredibly vulnerable transition period, particularly in areas of adherence to HIV treatment, cognitive development, mental health, sexual risk taking behaviors and alcohol/drug misuse. The renewal (2020-2025) will build on the Suubi+Adherence study to conduct one of the largest and longest running studies of YLHIV in SSA during a developmental period marked by profound biological and psychological maturation, and development transitional milestones. In this next phase, we will add a qualitative component to examine participants' experiences with the FEE program as well as long-term effects. Innovatively, we will also assess the impact of the FEE on cognitive functioning. The study specific aims are: Aim 1. To examine the long-term impact of the Suubi+Adherence intervention on: HIV viral suppression (primary outcome) and to explore the long-term impact of the intervention on key HIV treatment adherence outcomes for YLHIV, including participants' ability to access and refill prescribed medication, adhere to prescribed daily medication routines, and engage in HIV care; Aim 2. To elucidate the long-term effects of the Suubi+Adherence intervention on potential mechanisms of change, including: a) economic stability, sexual risk- taking behavior, adherence self-efficacy; b) cognitive functioning; c) mental health functioning; and d) young adult transitions and social support; Aim 3. To qualitatively examine– prospectively and retrospectively: a) multi- level factors affecting participants' maintenance of intervention benefits since Suubi+Adherence intervention initiation (prospectively); and b) participants' experiences with the intervention (retrospectively), including multi- level factors that may have influenced their engagement with the program and their decision-making in regard to ART adherence; Aim 4. To examine the long-term cost-effectiveness of the Suubi+Adherence intervention. The study is aligned with the National Institutes of Health Office of AIDS Research priorities.