Efficacy of a differentiated care intervention for adolescents transitioning to adult HIV care in Peru - The transition from pediatric to adult care is an exceptionally precarious period in adolescent HIV care, yet little is known about which interventions are most effective in supporting adolescents through this transition. We will build on our well-established community health platform and prior intervention research among adolescents and young adults living with HIV in Lima, Peru, to generate critical evidence on the effectiveness, cost, and implementation of a promising community-based differentiated care intervention. In our recent pilot study among 30 adolescents, the intervention was highly acceptable and associated with improvements in adherence, social support, self-efficacy, and transition readiness. The intervention includes stabilization of acute needs (e.g., housing instability or homelessness), health system navigation to address administrative barriers (e.g., insurance changes and clinic transfers), accompaniment to adult clinic appointments, peer support groups, education and skills-building sessions, and mental health screening and referral. The intensity and duration of support will be tailored based on individual factors such as adherence, viral suppression, family support, and transition readiness. We will conduct a two-arm randomized clinical trial to evaluate the short- and long-term efficacy of the intervention in improving retention in care with viral load suppression, as well as other indicators of HIV-related and overall well-being. We will compare the cumulative incidence of unsuccessful transition at 12 and 24 months and assess outcomes by differentiated care pathway. We will generate implementation and costing data essential for uptake, sustainability, and public-sector adoption, including intervention reach and the relative contribution of individual components over time. Although this research will be conducted in Peru, it addresses a challenge that is highly relevant to the United States. Adolescents and young adults living with HIV in the U.S. face many of the same barriers during the transition to adult care, including mental health comorbidities, stigma, unstable housing, and disengagement from care. These challenges contribute to suboptimal retention and viral suppression. By rigorously evaluating a scalable, low-cost intervention delivered by lay health workers, this study will generate generalizable evidence on how to improve transition outcomes for adolescents living with HIV. The effectiveness, implementation, and cost-effectiveness data produced by this project will inform adaptation of similar models within the United States, thereby contributing to efforts to improve long-term HIV outcomes and reduce HIV transmission among American adolescents and young adults living with HIV.
