Sustaining Innovative Tools to Expand Youth-Friendly HIV Self-Testing (S-ITEST)

尼日利亚的许多青少年和年轻人（AYA，14-24岁）有很大的艾滋病毒风险，但没有 接受艾滋病预防服务。虽然暴露前预防（PrEP），艾滋病毒自我检测，性传播 感染（STI）检测和与AYA友好临床服务的联系是必不可少的，但它们还没有得到广泛的应用。 在尼日利亚实施或维持的。这强调了实施科学的重要性， 在不同的环境中为AYA提供艾滋病毒预防服务。我们的4青年 （4 YBY）计划（NICHD UH 3 HD 096929）利用了参与式实施策略，如众包 公开呼吁和设计马拉松和参与式学习社区，以发展AYA领导的PrEP吸收，艾滋病毒 自我检测和性传播感染检测服务在尼日利亚。NICHD资助的预防和治疗的成功 在资源有限的环境中为受艾滋病毒影响的青少年提供全面的连续护理 实施（PATC 3 H）试点项目促进了向NICHD U支持的随机对照 在32个地方政府区域进行试验。中期数据表明，4 YBY计划是有效的，但 如何将这项研究转化为实践，并使之在尼日利亚的AYA长期持续下去，需要进一步的研究 调查作为一个跨专业的研究团队，我们有着良好的往绩，我们建议以下具体的 目标：（1）对尼日利亚青年采用参与性办法（即众包设计马拉松， 参与式学习社区）制定新的战略，以维持4 YBY计划;（2） 评估最终确定的维持战略的有效性，以维持4 YBY计划的核心要素 在尼日利亚的高危人群中，HIV阴性的AYA（14-24岁）使用了一项在32个新的 （3）评估整个4 YBY计划的影响和成本效益。我们定义 基于4 YBY计划的核心要素在足够保真度的基础上的持续维持， 预期利益的延续，以及继续该方案的足够能力。青年 我们的研究将参考先行行动研究框架和PEN-3文化模式。执行 科学方面将以普罗克特的实施成果框架和综合 实施研究框架（CFIR）。我们还将估计实施的成本， 支持4 YBY计划。我们目前正在32个地方实施4 YBY， 24个月的AYA人口。在这个队列中，我们将整合最终的维持战略， 长期维持数据。此外，我们将招募32个新的风险较高的当地地区（符合PrEP条件） AYA将与4 YBY（16个区域）或标准4 YBY一起接受相同的维持战略 项目（16个）。S-ITEST（Sustaining Innovative Tools to Expand HIV Self） 测试）研究将与其他设置相关。S-ITEST响应联合国确定的高优先级主题 美国国立卫生研究院、NICHD、NIMH、FIC和OBSSR。

Many adolescents and young adults (AYA, 14-24 years old) in Nigeria have a substantial HIV risk but do not receive HIV prevention services. While pre-exposure prophylaxis (PrEP), HIV self-testing, sexually transmitted infection (STI) testing, and linkage to AYA-friendly clinical services are essential, they have not been widely implemented or sustained in Nigeria. This underlines the importance of implementation science to increase the adoption and maintenance of HIV prevention services for AYA in diverse settings. Our 4 Youth by Youth (4YBY) program (NICHD UH3HD096929) leveraged participatory implementation strategies like crowdsourcing open calls and designathons and participatory learning communities to develop AYA-led PrEP uptake, HIV self-testing, and STI testing services in Nigeria. The success of this NICHD-funded Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings Implementation (PATC3H) pilot program facilitated transition to an NICHD U-supported randomized controlled trial underway in 32 local government areas. Interim data demonstrates that the 4YBY program is effective, but how to transition this research study into practice and sustain it overtime for AYA in Nigeria requires further investigation. As a multi-disciplinary research team with proven track record, we propose the following specific aims: (1) To use participatory approaches with Nigerian youth (i.e. crowdsourcing designathons and participatory learning communities) to develop new strategies for sustaining the 4YBY program; (2) To evaluate the effectiveness of a finalist sustainment strategy to sustain core elements of the 4YBY program among at-risk, HIV-negative AYA (14-24 years old) in Nigeria using a cluster randomized control trial in 32 new local areas; (3) To estimate the impact and cost-effectiveness of the overall 4YBY program. We define sustainment based on the continuation of core elements of the 4YBY program at sufficient fidelity, the continuation of intended benefits, and adequate capacity for the continuation of the program. The Youth Participatory Action Research framework and the PEN-3 cultural model will inform our study. Implementation science aspects will be guided by the Proctor’s Implementation Outcomes Framework and the Consolidated Framework for Implementation Research (CFIR). We will also estimate the cost of implementing and sustaining the 4YBY program. We are currently implementing 4YBY in 32 local areas among a general population of AYA for 24 months. Within this cohort, we will integrate the final sustainment strategy and collect data on sustainment over time. In addition, we will recruit 32 new local areas with higher risk (PrEP-eligible) AYA that will either receive the same sustainment strategy alongside 4YBY (16 areas) or a standard 4YBY program (16 areas). Findings from the proposed S-ITEST (Sustaining Innovative Tools to Expand HIV Self- testing) study will be relevant in other settings. S-ITEST responds to high-priority topics identified by the United States National Institutes of Health, NICHD, NIMH, FIC, and OBSSR.