Strategic antiretroviral therapy and HIV testing for youth in rural Africa

摘要 尽管撒哈拉以南非洲地区成人艾滋病毒携带者的艾滋病毒治疗成果令人鼓舞， 感染艾滋病毒的青少年和青壮年(10-24岁)被留在了 年轻女性受到的影响不成比例。Ayah的艾滋病毒检测率更低，与护理的联系更差， 保留在护理中，并显著降低艾滋病毒病毒抑制率。我们的目标是评估一个 一项整群随机对照试验(RCT)中对Ayah(土星)的战略ART联合干预 在乌干达和肯尼亚农村的28个诊所的1400个Ayah。土星是一个创新的生命阶段-适应 改善女性和男性对ART的摄取、黏附、滞留和病毒学抑制的方法 青春年华。适应生命阶段、组合土星干预的前提是当前 让Ayah参与的方法面临着缺乏动态灵活性和护理适应的挑战 认知、社交和生命阶段发展事件的重要轨迹 青春期和成年期早期。我们的干预是基于行为理论、实施 来自该区域的科学、青年/提供者投入，以及过程和结果的可行性和试点数据。在……里面 目标1，第一阶段(UG3)，我们将：a)实施青年主导的艾滋病毒检测和联系方案，使用 以社区为基础的参与性研究(CBPR)，以帮助未确诊或未参与的Ayah 护理b)启动土星干预的集群式随机对照试验，对照#年Ayah的护理标准 计划在乌干达和肯尼亚农村地区开设28家诊所。在目标2、阶段2(UH3)中，我们将：完成RCT 从28个诊所登记Ayah，并比较2个诊所的滞留率和病毒学抑制率 在土星诊所与对照的年份；以及2a)确定行动机制、障碍和促进者 在社区、诊所组织、提供者和患者级别使用MIXED 方法定性与定量相结合的评价方法。2b)估计相关的增量成本和收益 通过成本效益分析与土星合作。从UG3向UH3过渡的里程碑：A) 从前8家诊所招募至少400名青年参加土星RCT；2)在登记的人中，20%将是新的或 保健外诊断；3)在干预1年时，通过病毒抑制实现至少70%的保留率 社区。这项研究建立在各部委之间卓有成效的长期合作的基础上 乌干达和肯尼亚的卫生、非洲和美国的研究组织以及PEPFAR的实施伙伴 在当地社区的参与和大量的Ayah有针对性地在乌干达和肯尼亚开展形成性工作，并正在 以最终传播和可持续性为目标。

SUMMARY Despite encouraging gains in HIV treatment outcomes among adults with HIV in Sub-Saharan Africa, adolescents and young adults(10-24 years of age) living with HIV (AYAH) are being left behind with young women disproportionately affected. AYAH have worse rates of HIV testing, linkage to care, retention in care, and dramatically lower rates of HIV viral suppression. Our goal is to evaluate a strategic ART combination intervention for AYAH (SATURN) in a cluster randomized controlled trial (RCT) of 1,400 AYAH in 28 clinics in rural Uganda and Kenya. SATURN is an innovative life-stage adapted approach to improve ART uptake, adherence, retention and virologic suppression among female and male youth. The life-stage adapted, combination SATURN intervention is based on premise that current approaches to engaging AYAH are challenged by lack of dynamic flexibility and care adaptation to the significant trajectories of cognitive, social, and life-stage developmental events that occur in adolescence and early adulthood. Our intervention is based on behavioral theory, implementation science, youth/provider input, and process and outcome feasibility and pilot data from the region. In AIM 1, Phase-I (UG3), we will: a) Implement youth-led HIV testing and linkage programs using a community-based participatory research (CBPR) to reach AYAH who are undiagnosed or are not engaged in care b) Initiate the clustered RCT of SATURN intervention compared to standard of care among AYAH in 8 of the planned 28 clinics in rural Uganda and Kenya. In AIM 2, Phase-2 (UH3) we will: Complete RCT enrollment of AYAH from 28 clinics and compare the rate of retention and virologic suppression at 2 years in SATURN clinics vs control; and 2a) Identify the mechanisms of action, barriers and facilitators of the SATURN implementation at the community, clinic organization, provider, and patient levels using mixed methods qualitative and quantitative assessments. 2b) Estimate the incremental costs and gains associated with SATURN through cost effectiveness analysis. Transition Milestones to move from UG3 to UH3: a) Enroll at least 400 youth from the first 8 clinics to the SATURN RCT; 2) Of those enrolled, 20% will be new or out-of-care diagnoses; 3) Achieve at least 70% retention with virologic suppression at 1 year in intervention communities. This research builds upon highly productive long-standing collaborations between Ministries of Health in Uganda and Kenya, African and US research organizations, and PEPFAR implementing partners with local community participation and substantial AYAH targeted formative work in Uganda and Kenya and is directed at eventual dissemination and sustainability.