Adolescent Coordinated Transition to Improve Outcomes among Nigerian HIV+ Youth (ACT STUDY)

The ACT Study award is a five – year NIH research grant to University of Las Vegas (UNLV) and the collaborating Nigeria Implementing Partners (IPs) including Institute of Human Virology, Nigeria (IHVN); AIDS Prevention Initiative, Nigeria (APIN); Center for Clinical Care and Research, Nigeria (CCCRN); Center for Integrated Health Programmes (CIHP) and Family Health International (FHI360)

Background

ACT Study is National, multi – region, multi – center Cluster Randomized study premised on the background of high mortality (50%) among HIV infected, high HIV burden among adolescents in Nigeria, poor health outcomes for adolescents living with HIV in Nigeria, the need for a coordinated multidisciplinary and culturally appropriate approaches that are necessary to successfully transition patients from paediatric to adult care, identified several educational, logistic and psychosocial barriers that impair successful transition of care for ALHIV, and less developed transition models for ALHIV compared to other chronic diseases. Other background support for the study include need to have elements for a successful transition from paediatric to adult care like psychosocial support, provision of information on social issues to the adolescents etc., need for a feasible, acceptable and sustainable model of transition of care for ALHIV in resource – limited settings such as Nigeria.

ACT Study aims are:

  1. Determine the impact of ACT on retention in care among ALHIV.
  2. Evaluate the impact of ACT on viral suppression rates among ALHIV.
  3. Examine the impact of the planned ACT intervention on the psychosocial wellbeing of adolescents.

Significance of the Study
ACT Study is significant because: (1) Nigeria is a high – burden country with the second largest population of ALHIV worldwide. Successful interventions in Nigeria will have significant impact on health outcomes indicators among ALHIV globally. 2) Ineffective transfer from paediatric to adult care is associated with poor health outcomes and can be reduced with a successful transition process to adult care leading to higher post – transition retention in care, viral suppression and wellbeing among adolescents. Well – designed implementation science studies demonstrating successful models of transition of care for ALHIV in resource – limited settings are scarce. Feasible, acceptable, low cost and sustainable transition approaches remain crucial especially in resource – limited settings. (4) Implementation research that utilize the large PEPFAR investment and existing program infrastructure in resource – limited countries are more likely to be feasible and sustainable.

Inclusion criteria for ACT Study
ACT Study is being conducted in PEPFAR supported comprehensive ART sites with both paediatric and adult HIV services established for at least 12 months to increase feasibility of intervention.
ACT Study outcomes include:
1) Retention, defined as proportion of patients known to be alive and receiving highly active ART at the end of a follow – up period at 12 and 24 months post – transfer respectively
2) HIV Viral Load suppression, defined according to the Nigerian guidelines as plasma viral load (VL) of <400 copies/ml after ≥24 weeks of ART
3) We will evaluate psychosocial health with respect to successful transitioning