Bridges-Round 2: Evaluating the Long-term Impact of a Family Economic Empowerment Intervention on HIV Risk Prevention and Care Continuum Outcomes among Orphaned Youth Transitioning to Young Adulthood

项目摘要 在全球范围内，青少年和青壮年(14-29岁)占艾滋病毒感染病例的30%。 育龄人口，约75%发生在撒哈拉以南非洲(SSA)。中国艾滋病毒发病率迅速上升 SSA，因为Aya离开学校(通常是过早的)，为了工作和婚姻而迁移。年龄较大的青少年更多 可能会尝试危害健康的行为，这些行为会增加他们对艾滋病毒和性行为的易感性 传播感染(STI)。因艾滋病成为孤儿的年轻人[YPoAIDS])，其中80%生活在SSA 一个特别脆弱和独特的群体。SSA的大多数青年艾滋病患者都经历了巨大的困难，包括 更高的艾滋病毒危险行为发生率和感染艾滋病毒的几率。这些逆境累积扰乱了 YPoAIDS的发展里程碑，并可能损害他们的健康和情感福祉。值得注意的是，我们的 团队在实施为期6年的三臂随机对照试验方面取得了巨大成功，该试验测试了基于家庭的经济 干预，布里奇斯(R01HD070727)，对乌干达农村1383名上小学的青少年(10-14岁)进行的调查 注册时年龄)因艾滋病失去父母一方或双方的人。在6年内保留率超过90% 在此期间(2012-2018)，我们的研究结果显示，这种情景驱动干预的有效性显著提高 性健康、在校学习保持和表现以及心理健康。然而，两项关键政策和规划 与艾滋病毒预防和参与护理连续体有关的问题仍未得到解决：1)长期 跨越YPoAIDS生命过程的桥梁的有效性目前尚不清楚，但至关重要，因为 在过渡到青年时期的独特脆弱性；和2)性健康的自我报告是 不可靠，因此需要集成生物标记物以提供这些高度相关的 (但目前尚不清楚)我们参与者的性健康结果。因此，大桥的具体目标是- 第二轮研究是：目标1.检查桥梁对：艾滋病毒流行率的长期影响(通过 参与者的艾滋病毒状况)(主要结果)；和b)在二次分析中探讨以下方面的长期影响 在关键发展和行为结果(例如，精神健康、酗酒和滥用药物)方面架起桥梁；目标2。 阐明桥梁对潜在变化机制的长期影响，包括：a)经济稳定； 病毒抑制(针对ALHIV)；PrEP使用(针对HIV阴性青少年)；医用男性包皮环切术(针对男孩)； 和b)年轻人的过渡；目标3：定性调查参与者的桥梁体验， 影响了项目的参与度、性冒险决定、财务行为；经历 与发展转型；以及对方案可持续性的看法；目标4：评估长期成本 使用正式的经济评价方法对桥梁的效益进行评估。我们的长期目标是将知识转化为 可持续的、理论指导的预防和治疗努力，促进受以下疾病影响的阿亚的福祉 在资源匮乏的情况下，艾滋病毒/艾滋病贯穿整个生命周期。

PROJECT ABSTRACT Globally, adolescents and young adults (AYA; ages 14-29) represent 30% of HIV incidence cases among persons of reproductive age, with ~75% occurring in Sub Saharan Africa (SSA). HIV incidence rises rapidly in SSA, as AYA leave school (often prematurely) and migrate for work and marriage. Older adolescents are more likely to experiment with health compromising behaviors that increase their vulnerability to HIV and sexually transmitted infections (STIs). Young people orphaned by AIDS [YPoAIDS]), 80% of which live in SSA represent a particularly vulnerable and unique population. Most YPoAIDS in SSA experience immense hardships, including higher rates of HIV risk behavior and odds of HIV infection. These adversities cumulatively disrupt the developmental milestones for YPoAIDS and can compromise their health and emotional wellbeing. Notably, our team has had great success with implementing a 6-year, three-armed RCT that tested a family-based economic intervention, Bridges (R01HD070727), among 1,383 primary school going adolescents in rural Uganda (10-14 years of age at enrollment) who lost one or both parents to AIDS. With over 90% retention rate over a 6-year period (2012-2018), our findings show efficacy of this contextually-driven intervention significantly improving sexual health, school retention and performance, and mental health. Yet, two critical policy and programming questions related to HIV prevention and engagement in care continuum remain unaddressed: 1) longer-term effectiveness of Bridges across YPoAIDS’s life course is currently unknown but critically important because of unique vulnerabilities during the transition into young adulthood; and 2) self-reports of sexual health are unreliable, hence the need to integrate biomarkers to provide the most precise results of these highly relevant (but currently unknown) sexual health outcomes among our participants. Thus, the specific aims of the Bridges- Round 2 study are: Aim 1. Examine the long-term impact of Bridges on: HIV prevalence (measured via participant’s HIV status) (Primary outcome); and b) Explore in secondary analyses the long-term impact of Bridges on key developmental and behavioral outcomes (e.g., mental health, alcohol and drug misuse); Aim 2. Elucidate the long-term effects of Bridges on potential mechanisms of change, including: a) economic stability, viral suppression (for ALHIV); PrEP use (for HIV negative adolescents), medical male circumcision (for boys); and b) young adult transitions; Aim 3: Qualitatively investigate participants’ experiences with Bridges that may have influenced engagement with the program, sexual risk-taking decisions, financial behaviors; experiences with developmental transitions; and perceptions on program sustainability; Aim 4: To assess the long-term costs and benefits of Bridges using formal economic evaluation. Our long-term goal is to translate knowledge into sustainable, theoretically-guided prevention and treatment efforts that promote the wellbeing of AYA affected by HIV/AIDS across the life course, in low-resource settings.