Implementation Research to Optimize ART Delivery for Adolescents and Young Adults Living with HIV

Johns Hopkins University, Baltimore MD

Investigators

Linked publications, trials & patents

Abstract

PROJECT SUMMARY This five-year K01 Mentored Research Scientist Development Award will provide Dr. Rucinski with the mentorship and training to become an independent investigator focused on research that optimizes the health and well-being of adolescents and young adults (AYA) at high risk of HIV acquisition and transmission in the United States (US). Training is at the foundation of this proposal and comprises mentorship with expert and multi-disciplinary HIV and implementation science (IS) researchers, didactic coursework, experiential learning, meetings with key stakeholders and community leaders, and rigorous mentored research. The following training objectives will be accomplished during this award: (1) Obtain scientific expertise in the concepts, theories, tools and methods used to advance HIV-related IS research and practice; (2) Develop comprehensive skills in qualitative research methods to support the application of mixed-methods approaches for HIV-related IS research; and (3) Acquire content expertise in adolescent health and development to inform the tailoring, adaptation, and testing of developmentally appropriate HIV services for AYA. Supported by these objectives, the proposed mentored research project will generate a tailored packaged of implementation strategies to strengthen contextually appropriate antiretroviral therapy (ART) programs for AYA aged 15-24 living with HIV in the US. In the US, 19% of all new annual HIV infections are among AYA. Youth living with HIV are less likely to achieve viral suppression compared to adults, with cohort data suggesting that as little as 12% of AYA new to care are able to achieve viral suppression within 6 months. The barriers AYA experience in accessing treatment in the US reflect broader global challenges documented in high-incidence settings, such as in sub-Saharan Africa. These barriers include mental health concerns, economic insecurity, and a lack of social support. Lessons from these settings demonstrate that models such as dedicated weekend clinic hours, peer mentorship, and other psychosocial services can support ART adherence and viral suppression for AYA living with HIV. Given the rapidly evolving landscape of HIV treatment in the US, including through innovations such as long-acting injectables, there is an urgent need to develop strategies that support youth living with HIV to initiate and continue on ART, to conduct this research in a way that is efficient, and to apply global programmatic lessons to the US context with the overall goal of optimizing adolescent health. Guided by the Consolidated Framework for Implementation Research, we propose the following aims: (1) Examine the social, structural, and clinic-level factors associated with retention in care and HIV viral suppression among AYA who were newly infected or diagnosed with HIV; (2) Refine a tailored package of implementation strategies to optimize HIV treatment for AYA living with HIV; and (3) Evaluate the preliminary effectiveness of a combined psychosocial/structural intervention in improving HIV viral suppression for AYA living with HIV. Findings will form the foundation for a R01-level randomized hybrid effectiveness trial and will facilitate Dr. Rucinski’s transition to independence.