Self-Management among adolescents living with HIV in Uganda

PROJECT SUMMARY/ABSTRACT
There are over 73,000 adolescents living with HIV (ALHIV) in Uganda constituting 4% of the worldwide
population of ALHIV. HIV remains a leading cause of death among adolescents despite widespread availability
of antiretroviral medication. Generally, ALHIV have poor outcomes with higher rates of loss to follow up
compared with other age groups. Mortality rates and loss to follow up are highest during the transition period.
Transition success may be maximized for ALHIV who are better prepared to negotiate care in adult HIV clinic
settings. This preparation can include skills training to improve self-efficacy, resilience, and education to
address lack of HIV knowledge, both of which are predictive of better outcomes following transition. Provision
of psychosocial support and preparatory information to navigate adult HIV care services have also been
associated with successful transition. The overall goal of the proposed K43 application is to complement my
clinical background in psychiatry with advanced coursework and focused mentoring in behavioral science and
development and testing of behavioral interventions to improve transition in care. This training will enable me
to achieve my scientific objective: to develop and test a self-management intervention for ALHIV transitioning
to adult HIV care. This training will enable me to achieve my scientific objective: to develop and test a self-
management intervention for ALHIV. This application proposes to develop a self-management intervention for
ALHIV transitioning to adult HIV care and test the impacts of the intervention on HIV outcomes. Conducting the
proposed studies in this application will complement my prior training in psychiatry while filling key gaps in
three areas: (a) behavioral science theories and their application to behavioral interventions, (b) adaptation and
design of behavioral interventions, and (c) testing of behavioral interventions through randomized trials. To fill
these gaps, I will conduct qualitative research to elaborate a conceptual framework of the barriers faced by
ALHIV transitioning to adult HIV care in Uganda (Aim 1), develop a self-management intervention that will
enable ALHIV to successfully transition to adult HIV care (Aim 2), and assess feasibility, acceptability, and
preliminary effects of the self-management intervention on HIV outcomes for ALHIV transitioning to adult HIV
care (Aim 3). This study will be the first to develop a self-management intervention targeting the critical
transition period from pediatric to adult HIV care in sub-Saharan Africa and the first to use a randomized
design to test the effect of a self-management intervention on health outcomes among ALHIV in Uganda who
are transitioning to adult HIV care. These findings will have significant public health impact by optimizing health
outcomes for a key population in the global HIV epidemic. The proposed research will serve as the basis for a
competitive R01 grant proposal, submitted in year 4, to conduct a fully-powered, randomized controlled trial to
evaluate the effectiveness of a behavioral intervention to improve retention in care and viral suppression
among ALHIV in Uganda who are navigating the critical period of transition to adult HIV care.

Grant Number: 5K43TW011929-05
NIH Institute/Center: NIH
Principal Investigator: Scholastic Ashaba