CombinADO: Evaluation of an Intervention Aimed At Improving HIV Outcomes Among Adolescents and Young Adults Living with HIV in Mozambique

NCT ID: NCT04930367

Last Updated: 2024-09-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1715 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-09-13

Study Completion Date

2023-08-04

Brief Summary

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This is a cluster-randomized trial designed to compare the effectiveness of the CombinADO strategy versus optimized standard of care (SOC) on viral suppression, antiretroviral therapy (ART) adherence and retention in HIV care among adolescents living with HIV (ALHIV) ages 10 to 24 years attending participating health facilities. Clinics are the units of intervention allocation and randomization. The control condition will be implemented at all facilities (n=12) participating in the trial. The enhanced intervention condition will be superadded to this at a randomly selected half (n=6) of facilities. The goal of this study is to learn whether an enhanced, tailored intervention helps AYAHIV do better with their HIV care (take their medications, stay in care) than the usual care that they receive.

Detailed Description

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HIV burden among adolescents and young people worldwide is substantial, with an estimated 1.7 million adolescents aged 10-19 years living with HIV in 2019, and 460,000 adolescents aged 15-24 newly infected reported in the same year. Adolescent girls continue to be disproportionately affected, accounting for 56% of new infections worldwide. With increased availability of antiretroviral therapy (ART), pediatric mortality has decreased and healthcare workers (HCW) are now challenged to meet the complex needs of the large number of surviving youth who must cope with HIV as a chronic, highly stigmatized, and transmittable illness. There are 1.8 billion people between ages 10 and 24 and it is projected that the number of people \<20 years will double by 2030. In sub-Saharan Africa (SSA), youth aged 10-24 years comprise 30-35% of the countries' population. Failure to prevent new HIV infections among adolescents will result in increased numbers of adolescents and young adults living with HIV (AYAHIV) who will strain health and social service systems as they transition to adulthood.

Conditions

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HIV

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A cluster-randomized trial to compare the effectiveness of the CombinADO strategy versus optimized standard of care (SOC) on viral suppression, ART adherence and retention in HIV care among AYAHIV ages 10-24yrs attending participating health facilities. Clinics are the units of intervention allocation and randomization. The control condition will be implemented at all facilities (n=12) participating in the trial. The enhanced intervention condition will be superadded to this at a randomly selected half (n=6) of facilities.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Enhanced Standard of Care

To be implemented at all 12 clinic sites, includes a set of interventions aimed at optimizing the national standard of care (billboards/posters and radio shows, healthcare worker training, one-stop adolescent and youth friendly services, information/motivation walls, pill containers and tools to be used by clinic staff during clinical visits)

Group Type ACTIVE_COMPARATOR

Radio Ads

Intervention Type BEHAVIORAL

Engaging radio mini shows that address community stigma and medical literacy through busting common myths with humor and building empathy with heartfelt storytelling.

Community Sensitization Campaign

Intervention Type BEHAVIORAL

Large-scale, infographic billboards and posters located in public areas and secondary schools to address stigma, medical literacy and promote community support for AYAHIV.

Informational Posters

Intervention Type BEHAVIORAL

Large-scale, infographic posters located in clinic waiting areas to normalize HIV and build confidence in treatment.

Motivation Walls

Intervention Type BEHAVIORAL

Interactive, patient-generated posters located in the consultation room where patients can post words and phrases about themselves and their futures.

Pill Container

Intervention Type OTHER

A discreet pill container to support ART adherence.

CombinADO-specific training for healthcare workers

Intervention Type OTHER

Comprehensive in-service training for healthcare workers focused on the needs of adolescents and young adults living with HIV

One Stop Shop Model of Care

Intervention Type OTHER

Model of care that allows adolescents and young adults living with HIV to access a complete set of services, including HIV care, in one central location.

Treatment Toolkit

Intervention Type OTHER

A guide to clinic visits and discussions on ART and viral load monitoring to help healthcare workers better communicate with patients.

Self-reflection Kit

Intervention Type OTHER

A simple handout for healthcare workers to help patients reflect on their ART progress and understand the concept of viral load as a measure of ART success.

CombinADO Strategy

To be implemented at 6 randomly selected clinic sites, includes all interventions in the "Enhanced Standard of Care" arm plus five additional intervention components, including 1) Mental health screening and linkage to adolescent-focused mental health support, 2) peer navigation support, 3) an informational video, 4) peer support groups for AYAHIV and 5) support groups for caregivers of AYAHIV

Group Type EXPERIMENTAL

Radio Ads

Intervention Type BEHAVIORAL

Engaging radio mini shows that address community stigma and medical literacy through busting common myths with humor and building empathy with heartfelt storytelling.

Community Sensitization Campaign

Intervention Type BEHAVIORAL

Large-scale, infographic billboards and posters located in public areas and secondary schools to address stigma, medical literacy and promote community support for AYAHIV.

Informational Posters

Intervention Type BEHAVIORAL

Large-scale, infographic posters located in clinic waiting areas to normalize HIV and build confidence in treatment.

Motivation Walls

Intervention Type BEHAVIORAL

Interactive, patient-generated posters located in the consultation room where patients can post words and phrases about themselves and their futures.

Pill Container

Intervention Type OTHER

A discreet pill container to support ART adherence.

CombinADO-specific training for healthcare workers

Intervention Type OTHER

Comprehensive in-service training for healthcare workers focused on the needs of adolescents and young adults living with HIV

One Stop Shop Model of Care

Intervention Type OTHER

Model of care that allows adolescents and young adults living with HIV to access a complete set of services, including HIV care, in one central location.

Treatment Toolkit

Intervention Type OTHER

A guide to clinic visits and discussions on ART and viral load monitoring to help healthcare workers better communicate with patients.

Self-reflection Kit

Intervention Type OTHER

A simple handout for healthcare workers to help patients reflect on their ART progress and understand the concept of viral load as a measure of ART success.

Peer Support

Intervention Type BEHAVIORAL

Peer exposure to examples of adolescents and young adults openly living with HIV (AYAHIV) and; opportunities to share their experiences with HIV in one-on-one interactions with other AYAHIV during clinic visits.

Informational and motivational Video

Intervention Type BEHAVIORAL

An informational and motivational video that in simple language with engaging graphics that a) demystifies and simplifies HIV, ART, and viral load and; b) emphasizes that people can live long, healthy lives.

Support groups- caregivers of adolescents and young adults living with HIV

Intervention Type BEHAVIORAL

A learning, support, and empowerment group for caregivers of adolescents and young adults living with HIV (AYAHIV). Through monthly gatherings, the program aims to foster confidence, and equip caregivers with strategies to support AYAHIV adherence journey.

Support groups- adolescents and young adults living with HIV

Intervention Type BEHAVIORAL

A peer-to-peer learning, support, and empowerment group to address loss of hope and improve medical literacy. Through biweekly gatherings, the program aims to foster belonging and confidence, equipping young people and caregivers with strategies to navigate the adherence journey.

Mental health screening and linkage to adolescent-focused mental health support

Intervention Type BEHAVIORAL

HCWs will be trained in the use of a brief mental health screening tool focusing on depression, anxiety, and post-traumatic stress disorder. Mental health service providers at each facility will be trained and supported to provide diagnostic and mental health support to youth with positive screens who agree to further evaluation.

Interventions

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Radio Ads

Engaging radio mini shows that address community stigma and medical literacy through busting common myths with humor and building empathy with heartfelt storytelling.

Intervention Type BEHAVIORAL

Community Sensitization Campaign

Large-scale, infographic billboards and posters located in public areas and secondary schools to address stigma, medical literacy and promote community support for AYAHIV.

Intervention Type BEHAVIORAL

Informational Posters

Large-scale, infographic posters located in clinic waiting areas to normalize HIV and build confidence in treatment.

Intervention Type BEHAVIORAL

Motivation Walls

Interactive, patient-generated posters located in the consultation room where patients can post words and phrases about themselves and their futures.

Intervention Type BEHAVIORAL

Pill Container

A discreet pill container to support ART adherence.

Intervention Type OTHER

CombinADO-specific training for healthcare workers

Comprehensive in-service training for healthcare workers focused on the needs of adolescents and young adults living with HIV

Intervention Type OTHER

One Stop Shop Model of Care

Model of care that allows adolescents and young adults living with HIV to access a complete set of services, including HIV care, in one central location.

Intervention Type OTHER

Treatment Toolkit

A guide to clinic visits and discussions on ART and viral load monitoring to help healthcare workers better communicate with patients.

Intervention Type OTHER

Self-reflection Kit

A simple handout for healthcare workers to help patients reflect on their ART progress and understand the concept of viral load as a measure of ART success.

Intervention Type OTHER

Peer Support

Peer exposure to examples of adolescents and young adults openly living with HIV (AYAHIV) and; opportunities to share their experiences with HIV in one-on-one interactions with other AYAHIV during clinic visits.

Intervention Type BEHAVIORAL

Informational and motivational Video

An informational and motivational video that in simple language with engaging graphics that a) demystifies and simplifies HIV, ART, and viral load and; b) emphasizes that people can live long, healthy lives.

Intervention Type BEHAVIORAL

Support groups- caregivers of adolescents and young adults living with HIV

A learning, support, and empowerment group for caregivers of adolescents and young adults living with HIV (AYAHIV). Through monthly gatherings, the program aims to foster confidence, and equip caregivers with strategies to support AYAHIV adherence journey.

Intervention Type BEHAVIORAL

Support groups- adolescents and young adults living with HIV

A peer-to-peer learning, support, and empowerment group to address loss of hope and improve medical literacy. Through biweekly gatherings, the program aims to foster belonging and confidence, equipping young people and caregivers with strategies to navigate the adherence journey.

Intervention Type BEHAVIORAL

Mental health screening and linkage to adolescent-focused mental health support

HCWs will be trained in the use of a brief mental health screening tool focusing on depression, anxiety, and post-traumatic stress disorder. Mental health service providers at each facility will be trained and supported to provide diagnostic and mental health support to youth with positive screens who agree to further evaluation.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

1. HIV-positive, per medical records and confirmed by health facility staff
2. Age 10 to 24 years
3. Registered as a patient at study site
4. Aware of HIV+ status
5. Provision of signed and dated informed consent form
6. For adolescents under 18 years of age, informed assent and parental informed consent to participate in the study
7. Stated willingness to comply with all study procedures


1. Age 18 years and older
2. Attending a caregiver-specific support group
3. Willingness to be audio-recorded

Healthcare Workers (HCW) and Key Informants (KI):


1. Age 18 years and older
2. Involved in the provision, management, or oversight of adolescent-focused HIV services at the 12 specified study sites
3. Willingness to be audio-recorded

For all study participants (AYAHIV, caregivers, HCW and KI):

Exclusion Criteria

1\. Has an acute medical condition requiring immediate medical care

Caregivers of AYAHIV:


Any other condition, including but not limited to alcohol or substance abuse and uncontrolled medical condition and/or allergies, that, in the opinion of the study team, would preclude informed consent, make study participation unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives would make the patient unsuitable for the study or unable/unwilling to comply with the study requirements.
Minimum Eligible Age

10 Years

Maximum Eligible Age

24 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Cape Town

OTHER

Sponsor Role collaborator

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Columbia University

OTHER

Sponsor Role lead

Responsible Party

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Elaine J. Abrams, MD

Senior Research Director, ICAP

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Elaine J Abrams, MD

Role: PRINCIPAL_INVESTIGATOR

ICAP at Columbia University

Locations

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Cs 1 de Maio

Nampula, , Mozambique

Site Status

Cs 25 Setembro

Nampula, , Mozambique

Site Status

Cs Alua

Nampula, , Mozambique

Site Status

Cs Anexo Psi

Nampula, , Mozambique

Site Status

Cs Malema

Nampula, , Mozambique

Site Status

Cs Muhala Expansao

Nampula, , Mozambique

Site Status

Cs n1 Nacala Porto

Nampula, , Mozambique

Site Status

Cs Nametil

Nampula, , Mozambique

Site Status

Cs Namialo

Nampula, , Mozambique

Site Status

Cs Namicopo

Nampula, , Mozambique

Site Status

HG Marere

Nampula, , Mozambique

Site Status

HR Angoche

Nampula, , Mozambique

Site Status

Countries

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Mozambique

References

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Mogoba P, Falcao J, Tolla T, Zerbe A, De Gusmao EP, Myer L, Abrams EJ. A qualitative evaluation of stakeholder perspectives on the implementation of HIV services within adolescent and youth-friendly services for the youth in Nampula, Mozambique. BMC Health Serv Res. 2025 Sep 30;25(1):1229. doi: 10.1186/s12913-025-13414-0.

Reference Type DERIVED
PMID: 41029606 (View on PubMed)

Mogoba P, Lesosky M, Mukonda EE, Zerbe A, Falcao J, Zandamela R, Myer L, Abrams EJ. Positive attitudes toward adoption of a multi-component intervention strategy aimed at improving HIV outcomes among adolescents and young people in Nampula, Mozambique: perspectives of HIV care providers. BMC Health Serv Res. 2023 Jun 6;23(1):582. doi: 10.1186/s12913-023-09630-1.

Reference Type DERIVED
PMID: 37280638 (View on PubMed)

Mogoba P, Lesosky M, Zerbe A, Falcao J, Mellins CA, Desmond C, Arnaldo C, Kapogiannis B, Myer L, Abrams EJ. The CombinADO study to assess the impact of a combination intervention strategy on viral suppression, antiretroviral therapy adherence, and retention in HIV care among adolescents and young people living with HIV: protocol for a cluster-randomized controlled trial. Trials. 2021 Dec 27;22(1):956. doi: 10.1186/s13063-021-05943-w.

Reference Type DERIVED
PMID: 34961567 (View on PubMed)

Other Identifiers

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4UH3HD096926-03

Identifier Type: NIH

Identifier Source: secondary_id

View Link

AAAT5971

Identifier Type: -

Identifier Source: org_study_id

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