# Data-informed Stepped Care (DiSC) to Improve Adolescent HIV Outcomes

> **NIH NIH UH3** · UNIVERSITY OF WASHINGTON · 2021 · $928,664

## Abstract

PROJECT SUMMARY/ABSTRACT
Adolescents (ages 10-19) experience disproportionately low retention, antiretroviral (ART) adherence and viral
suppression compared to other age groups. HIV care programs in high prevalence, resource-limited settings
have developed innovative approaches to improve linkage, retention and viral suppression, including simplified
treatment regimens, task-shifting, and peer support. However, clear policies and practices for enrolling
adolescents in HIV services and research, as well as systematic strategies that identify adolescents who need
more intensive care to successfully achieve key milestones along the HIV care continuum, are lacking. ‘Stepped
care’ approaches, where the most at-risk clients receive increasing levels of intensity and frequency of care,
have been used to target interventions and efficiently use resources. A clinical prediction tool using standardized
risk scores can help healthcare providers to identify adolescents at greater risk of experiencing negative
outcomes and direct interventional support to them. Our data-informed stepped care (DiSC) intervention pairs
stepped care with a clinical prediction tool to optimize limited resources and improve HIV care and treatment
outcomes. Our team, which has worked with pediatric and adult HIV programs in Kenya for over two decades,
including an established repertoire of adolescent HIV studies, proposes to implement this combination data-
driven intervention using a stepped care model to inform public health decision-making and improve adolescent
HIV care in Kenya. Formative work in UG3 will include establishment of a clinic-based prospect cohort of
adolescents ages 10-19 and their care givers at 6 high volume HIV clinics in Western Kenya. Based on data
derived from surveys and abstraction of electronic medical records, we will determine key predictors of loss to
care and suspected virologic failure, and develop a clinical prediction tool to identify adolescents needing more
intensive support. We will conduct focus groups and interviews to understand and optimize adolescent consent
and representative participation in HIV care and research. This work, including adolescent and community
stakeholder perspectives, will inform development and optimization of the DiSC intervention for adolescent HIV
treatment management in UH3. DiSC will be evaluated through a cluster randomized trial at 20 high-volume HIV
clinics, looking at both effectiveness (6 and 12-month retention, viral suppression, ART adherence) and
implementation outcomes (feasibility and acceptability). These aims have potential to provide a generalizable,
systematic approach to deliver differentiated adolescent HIV care that integrates with diverse HIV care programs
and available support options to accelerate progress toward achieving the 90-90-90 targets for adolescents.

## Key facts

- **NIH application ID:** 10252949
- **Project number:** 5UH3HD096906-04
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Grace C. John-Stewart
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $928,664
- **Award type:** 5
- **Project period:** 2018-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10252949

## Citation

> US National Institutes of Health, RePORTER application 10252949, Data-informed Stepped Care (DiSC) to Improve Adolescent HIV Outcomes (5UH3HD096906-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10252949. Licensed CC0.

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