# Improving Retention in Care for Adolescents and Young Adults in Kenya: Implementation Science to Support Adaptation and Integration of a Stepped Care Intervention

> **NIH NIH F31** · UNIVERSITY OF WASHINGTON · 2024 · $22,391

## Abstract

Abstract
Worldwide, five million adolescents and young adults (AYA) are living with HIV. More than 90% of global HIV-
related mortality among AYA occurs in sub-Saharan Africa. A limited but growing evidence base of interventions
available for adolescents in sub-Saharan Africa highlight the importance of retention in care for improving
treatment outcomes. To meet AYA where they are in their engagement with the healthcare system, interventions
need to be feasible, acceptable, and appropriate for local healthcare settings and practice. This F31 project
leverages a cluster randomized controlled trial, Data-informed Stepped Care to Improve Adolescent HIV
Outcomes (UG3/UH3 HD096906; PIs: Kohler, John-Stewart) that is testing a Stepped Care intervention to
improve retention among adolescents and young adults living with HIV in western Kenya. This F31 project aims
to evaluate early phase implementation outcomes of the Stepped Care intervention as it is delivered across 10
healthcare facilities. Aim 1 will identify adaptations made to the intervention (materials, procedures, or delivery)
that influence acceptability, feasibility, and appropriateness. The Framework for Reporting Adaptations and
Modifications to Evidence-based interventions (FRAME) will be used to characterize adaptations and
modifications necessary for facility-specific optimization of the intervention. Aim 2 will identify the barriers and
facilitators that impact penetration, coverage, and fidelity of the Stepped Care intervention. We will apply the
Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators of
implementation to understand the context and intervention characteristics influencing implementation of the
Stepped Care intervention. Finally, Aim 3 will match barriers to successful implementation to targeted strategies
to overcome them, producing a package of intervention implementation options that promote long-term
intervention adoption and sustainability. Findings from this project will contribute to understanding optimization
of Stepped Care and provide valuable information about the context necessary for successful scale-up of
Stepped Care interventions for adolescents and young adults within Kenya or scale out to other global settings.
The research plan will provide the F31 candidate, an implementation science pre-doctoral student, with rigorous
training in (1) implementation science conceptual frameworks, models, design and methodology; (2) training in
qualitative methods; and (3) content-area expertise regarding evidence-based interventions for adolescents and
young adults living with HIV.

## Key facts

- **NIH application ID:** 10851993
- **Project number:** 5F31HD105513-03
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Nok Chhun
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $22,391
- **Award type:** 5
- **Project period:** 2022-06-16 → 2024-08-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10851993

## Citation

> US National Institutes of Health, RePORTER application 10851993, Improving Retention in Care for Adolescents and Young Adults in Kenya: Implementation Science to Support Adaptation and Integration of a Stepped Care Intervention (5F31HD105513-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10851993. Licensed CC0.

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