Cargando…

Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention

INTRODUCTION: Adolescents and youth living with HIV (AYLHIV) have lower retention in care, adherence to treatment, and viral suppression compared with adults. Stepped care is a process by which clients are assigned to increasingly intensive services or ‘steps’ according to level of need. Differentia...

Descripción completa

Detalles Bibliográficos
Autores principales: Kohler, Pamela, Agot, Kawango, Njuguna, Irene N, Dyer, Jessica, Badia, Jacinta, Jiang, Wenwen, Beima-Sofie, Kristin, Chhun, Nok, Inwani, Irene, Shah, Seema K, Richardson, Barbra A, Chaktoura, Nahida, John-Stewart, Grace
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9628651/
https://www.ncbi.nlm.nih.gov/pubmed/36316073
http://dx.doi.org/10.1136/bmjopen-2022-062134
_version_ 1784823233650884608
author Kohler, Pamela
Agot, Kawango
Njuguna, Irene N
Dyer, Jessica
Badia, Jacinta
Jiang, Wenwen
Beima-Sofie, Kristin
Chhun, Nok
Inwani, Irene
Shah, Seema K
Richardson, Barbra A
Chaktoura, Nahida
John-Stewart, Grace
author_facet Kohler, Pamela
Agot, Kawango
Njuguna, Irene N
Dyer, Jessica
Badia, Jacinta
Jiang, Wenwen
Beima-Sofie, Kristin
Chhun, Nok
Inwani, Irene
Shah, Seema K
Richardson, Barbra A
Chaktoura, Nahida
John-Stewart, Grace
author_sort Kohler, Pamela
collection PubMed
description INTRODUCTION: Adolescents and youth living with HIV (AYLHIV) have lower retention in care, adherence to treatment, and viral suppression compared with adults. Stepped care is a process by which clients are assigned to increasingly intensive services or ‘steps’ according to level of need. Differentiated care, in which stable clients access less frequent services, can be combined with stepped care to align needs and preferences of youth to promote optimal engagement in care. METHODS AND ANALYSIS: This hybrid type I effectiveness implementation cluster randomised trial aims to evaluate a data-informed stepped care (DiSC) intervention for AYLHIV. AYLHIV ages 10–24 receiving care at 24 HIV treatment facilities in Kisumu, Homabay and Migori counties in Kenya will be enrolled. Twelve facilities will be randomised to the DiSC intervention, and 12 will provide standard care. A clinical assignment tool developed by the study team will be used at intervention sites to assign AYLHIV to one of four steps based on risk for loss to follow-up: differentiated care, standard care, counselling services or intensive support services. The primary clinical outcome is retention in care, specifically missed visits (failure to return within 30 days for any visit) and 12-month loss to follow-up. Implementation outcomes are based on the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Proportions of missed visits will be compared using mixed effect models clustered by facility and participant. ETHICS AND DISSEMINATION: This study has been approved by the University of Washington Institutional Review Board (STUDY00011096), Maseno University Ethical Review Committee (MUERC/00917/20) and the Kenya National Commission for Science, Technology and Innovation (444824). AYLHIV provide written informed consent when legally permitted, or assent with caregiver permission for minors. Study staff will work with a Community Advisory Board, including youth members, to disseminate results via discussions, presentations, journal publications and local or international conferences. TRIAL REGISTRATION NUMBER: NCT05007717.
format Online
Article
Text
id pubmed-9628651
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-96286512022-11-03 Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention Kohler, Pamela Agot, Kawango Njuguna, Irene N Dyer, Jessica Badia, Jacinta Jiang, Wenwen Beima-Sofie, Kristin Chhun, Nok Inwani, Irene Shah, Seema K Richardson, Barbra A Chaktoura, Nahida John-Stewart, Grace BMJ Open Epidemiology INTRODUCTION: Adolescents and youth living with HIV (AYLHIV) have lower retention in care, adherence to treatment, and viral suppression compared with adults. Stepped care is a process by which clients are assigned to increasingly intensive services or ‘steps’ according to level of need. Differentiated care, in which stable clients access less frequent services, can be combined with stepped care to align needs and preferences of youth to promote optimal engagement in care. METHODS AND ANALYSIS: This hybrid type I effectiveness implementation cluster randomised trial aims to evaluate a data-informed stepped care (DiSC) intervention for AYLHIV. AYLHIV ages 10–24 receiving care at 24 HIV treatment facilities in Kisumu, Homabay and Migori counties in Kenya will be enrolled. Twelve facilities will be randomised to the DiSC intervention, and 12 will provide standard care. A clinical assignment tool developed by the study team will be used at intervention sites to assign AYLHIV to one of four steps based on risk for loss to follow-up: differentiated care, standard care, counselling services or intensive support services. The primary clinical outcome is retention in care, specifically missed visits (failure to return within 30 days for any visit) and 12-month loss to follow-up. Implementation outcomes are based on the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Proportions of missed visits will be compared using mixed effect models clustered by facility and participant. ETHICS AND DISSEMINATION: This study has been approved by the University of Washington Institutional Review Board (STUDY00011096), Maseno University Ethical Review Committee (MUERC/00917/20) and the Kenya National Commission for Science, Technology and Innovation (444824). AYLHIV provide written informed consent when legally permitted, or assent with caregiver permission for minors. Study staff will work with a Community Advisory Board, including youth members, to disseminate results via discussions, presentations, journal publications and local or international conferences. TRIAL REGISTRATION NUMBER: NCT05007717. BMJ Publishing Group 2022-10-31 /pmc/articles/PMC9628651/ /pubmed/36316073 http://dx.doi.org/10.1136/bmjopen-2022-062134 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Epidemiology
Kohler, Pamela
Agot, Kawango
Njuguna, Irene N
Dyer, Jessica
Badia, Jacinta
Jiang, Wenwen
Beima-Sofie, Kristin
Chhun, Nok
Inwani, Irene
Shah, Seema K
Richardson, Barbra A
Chaktoura, Nahida
John-Stewart, Grace
Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention
title Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention
title_full Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention
title_fullStr Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention
title_full_unstemmed Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention
title_short Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention
title_sort data-informed stepped care to improve youth engagement in hiv care in kenya: a protocol for a cluster randomised trial of a health service intervention
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9628651/
https://www.ncbi.nlm.nih.gov/pubmed/36316073
http://dx.doi.org/10.1136/bmjopen-2022-062134
work_keys_str_mv AT kohlerpamela datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT agotkawango datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT njugunairenen datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT dyerjessica datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT badiajacinta datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT jiangwenwen datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT beimasofiekristin datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT chhunnok datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT inwaniirene datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT shahseemak datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT richardsonbarbraa datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT chaktouranahida datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention
AT johnstewartgrace datainformedsteppedcaretoimproveyouthengagementinhivcareinkenyaaprotocolforaclusterrandomisedtrialofahealthserviceintervention