Scale it up: Effectiveness-implementation research to enhance HIV-related self-management among youth

Naar-King, Sylvie; Parsons, Jeffrey; Stanton, Bonita

Abstract

Despite the substantial declines in HIV transmission and increases in lifespan among those living with HIV achieved over the past decade, full benefits that should be possible based on the tools and interventions currently available have yet to be realized in youth, in large part because efficacious interventions for this age group have not been brought to scale. To be effective, youth must be fully engaged in interventions at every stage of the HIV care (treatment and prevention) cascades: HIV testing, linkage to care, timely initiation of care, persistence and adherence to antiretroviral care. At-risk HIV-negative youth need to be consistently engaged in prevention strategies such as PEP and/or PrEP as indicated, consistent safer sex practices and repeat HIV testing. Our U19 project - Scale It Up - specifically focuses on the process of improving self- management among youth including: 1) the identification of interventions that are efficacious and effective for improving self-management in YLH and at risk youth; 2) the multi-site implementation of an intervention shown to be efficacious in improving self-management; and 3) the assessment of the Five Components of Self- Management Model and how these vary over time, are directly improved by interventions, and mediate intervention effects. Our team has also been at the leading edge of implementation Science research related to HIV prevention and care. We are actively committed to aggressively moving beyond simple efficacy and effectiveness RCTs. The four Research Projects proposed in Scale It Up, all addressing self-management, will continue to develop the field of Implementation Science by employing three types of effectiveness- implementation hybrid designs. The studies further synergize by utilizing Aaron?s Exploration, Preparation, Implementation, Sustainment (EPIS) model to guide the proposed Implementation Science efforts. Our proposed Implementation Science Core, coupled with the cost effectiveness expertise of our Analytic Core, will be focused on the central notion of ?Scale It Up? ? taking efficacious self-management interventions and expeditiously moving them into practice while sustaining effectiveness. Scale It Up has assembled research teams who will develop, test, and bring to practice self-management interventions that positively impact the youth HIV prevention and care cascades. We will achieve these goals by: 1) Designing, conducting and evaluating self-management interventions grounded in the 5-component Self-Management Model and expeditiously moving effective programs into practice; 2) Developing, deploying and disseminating new methods for implementation and implementation analysis with a strong theoretical foundation; and 3) Engaging with the other funded U19s to identify additional opportunities to advance the implementation science and self- management science.

Public Health Relevance

This project will impact decision-making for the entire nation; results of all components of Scale It Up will inform self-management protocol and implementation in youth HIV care. Scale It Up specifically focuses on the process of improving self-management among youth including: 1) the identification of interventions that are efficacious and effective for improving self-management in YLH and at risk youth; 2) the multi-site implementation of an intervention shown to be efficacious in improving self-management; and 3) the assessment of the Five Components of Self-Management Model and how these vary over time, are directly improved by interventions, and mediate intervention effects. Our team has been at the leading edge of implementation science research related to HIV prevention and care, and this project will allow a wider field of delivery.