# Adaptive Strategies to Prevent and Treat Lapses of Retention in HIV Care for Adolescents (A4A)

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2021 · $588,163

## Abstract

Abstract
Adolescents and young adults (AYA) aged 14-24 years with HIV in Africa experience substantially
higher rates of viral failure and HIV-related mortality as compared to adults. Thus, effective public
health strategies tailored for and tested in this age group are urgently needed. The physical,
psychological and social transitions faced by AYA create unique susceptibilities to prevalent and
formidable structural (e.g., transport costs), psychosocial (e.g., the desire to fit in with peers,
stigma) and clinic-based (e.g., unfriendly providers, long waiting times) barriers to engagement in
public health HIV treatment settings. The variability in the intensity and the nature of barriers,
however, poses a critical challenge: if barriers are highly variable, then no individual interventions
are needed by all, while they also fail to help all in need. Adaptive strategies represent a novel
approach to such problems with no “silver-bullet” solutions, and which we hypothesize have
particular relevance for engagement of AYA in HIV treatment. Adaptive strategies typically begin
with a less intensive intervention, and then escalate to a more intensive intervention only in those
not doing well. Maintaining lower-intensity interventions in those doing well conserves resources
in the substantial fraction of AYA who do not need additional services, thereby enabling more
intensive support for those in need. While sequential multiple assignment randomized trials
(SMARTs), which are used to compare different sequences of interventions, have been used to
study mental illness, cancer therapy and HIV treatment, this proposal is the first to apply a SMART
to address engagement of AYA in HIV treatment in Africa. Within this design, we will use
developmentally appropriate interventions with high potential for effectiveness that will be tailored
by AYA pre-implementation. Specifically, we will randomize 880 AYA with HIV in Kenya to either
(1) youth-centered education & counseling (standard of care) vs. (2) addition of a SMS and peer
electronic navigator who provides support, information and counseling via phone. Those with a
lapse in engagement will be re-randomized a second time to one of three higher-intensity re-
engagement interventions: (1) standard of care outreach and intensified counseling, (2)
conditional cash transfers and (3) in-person peer navigation. The primary outcome will be a
combination of visit adherence and viral load suppression. This study will quantify the relative
effectiveness (and cost effectiveness) of several strategies composed of promising individual
interventions. We will assess provider and patient experiences and satisfaction with the
interventions using mixed methods. This innovative study will offer relevant evidence for public
health programming to end the AIDS epidemic for AYA with HIV.

## Key facts

- **NIH application ID:** 10205178
- **Project number:** 5R01NR018801-03
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Lisa Lynn Abuogi
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $588,163
- **Award type:** 5
- **Project period:** 2019-09-25 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10205178

## Citation

> US National Institutes of Health, RePORTER application 10205178, Adaptive Strategies to Prevent and Treat Lapses of Retention in HIV Care for Adolescents (A4A) (5R01NR018801-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10205178. Licensed CC0.

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