ABRAMS, ELAINE JANINE
UPROJECT ABSTRACT/ SUMMARYAdolescents are at the core of the global HIV epidemic. They are highly vulnerable to HIV acquisitionand?for adolescents living with HIV (ALHIV)?at disproportionate risk for poor health outcomesacross the HIV care continuum. Retention rates, adherence to antiretroviral treatment (ART), and viralsuppression (VS) are alarmingly low among ALHIV, warranting urgent attention. Adolescence is atime of rapid physical and psychological development, when youth move from childhood to adulthoodand experience multiple challenges as well as opportunities for growth, creativity, and learning. Youthwho enter this period under adverse conditions are ill prepared to cope with the impact of living with apotentially fatal, stigmatized, transmissible infection and the need to adopt positive, health-seekingbehaviors, engage with health services, and adhere to daily ART regimens. In high prevalencecountries like Mozambique, the burden of living with HIV during this vulnerable developmental stageis further exacerbated by fragile health systems and nascent ALHIV-specific differentiated servicedelivery (DSD) models. At the same time, few specific interventions have been developed and testedthat address the needs of ALHIV. In response, we propose to develop and test a culturally-appropriate, contextually-relevant, and theoretically-grounded adolescent-focused multicomponentintervention strategy, CombinADO, among ALHIV in Zambézia, Mozambique. Using a human-centered design approach, we will work with ALHIV, caregivers, health care providers, and local andnational stakeholders to develop and pilot this CombinADO intervention strategy consisting of fourcomponents: 1) ALHIV peer navigation and support, 2) adolescent-friendly services, 3) mHealthtechnologies, and 4) health communication messaging (Phase 1). In Phase 2, we propose to evaluatethe effectiveness of the CombinADO strategy on three milestones along the HIV care continuum: (a)retention in HIV care, (b) ART adherence, and (c) VS among ALHIV using a cluster randomizedcontrolled trial design. The study builds on longstanding partnerships between ICAP at ColumbiaUniversity, the Mozambique Ministry of Health and other local stakeholders, all aiming to improve thedisease course as well as outcomes along the continuum of care for this highly vulnerable population,adolescents living with HIV.