{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:15:52Z","timestamp":1771845352132,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007813","name":"Center for AIDS Research, University of Washington","doi-asserted-by":"publisher","award":["UW CFAR P30 AI027757"],"award-info":[{"award-number":["UW CFAR P30 AI027757"]}],"id":[{"id":"10.13039\/100007813","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UH3HD096906"],"award-info":[{"award-number":["UH3HD096906"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Systematic use of data\u2010driven tools to allocate care services based on needs, including differentiated care for stable individuals and intensive care for those with higher risk, may improve retention and viral suppression in adolescents and young adults living with HIV (AYLHIV).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cluster randomised trial in western Kenya tested a data\u2010informed stepped care intervention that assigned AYLHIV to four intensities of care according to need. AYLHIV at 12 intervention facilities underwent step assignment at each visit; those at lowest risk were offered differentiated models of service delivery (DSD), and those with risk factors more intensive services. AYLHIV at control sites received standard care. AYLHIV were followed for 12 months. Clinical and viral load data were abstracted from medical records. The primary outcome was the proportion of missed visits (defined as &gt;\u00a030 days late for scheduled visit). Secondary outcomes included loss to follow\u2010up, viral non\u2010suppression and assignment to DSD (multi\u2010month refills or pharmacy fast\u2010track visits). Mixed effects regression was clustered by individual and facility and adjusted for outcomes during the pre\u2010enrolment period and baseline variables that differed by arm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between April and July 2022, 1911 AYLHIV ages 10\u201324 were enrolled (control: 1016, intervention: 895, 1708.8 person\u2010years). Median age was 17, and 1512 (79.5%) were in school. Characteristics were balanced by arm, except for a higher proportion coming to the clinic alone in control arm (68.5% vs. 61.1%, <jats:italic>p<\/jats:italic> = 0.04). At intervention facilities, using the DiSC tool, 574 (64.6%) AYLHIV were assigned to DSD, 122 (13.7%) to standard care, 100 (11.3%) to mental health and retention counselling, and 92 (10.4%) to intensive case management. Missed visits were 8.5% in intervention versus 8.3% in control (adjusted risk ratio [aRR]: 1.04, 95% CI: 0.89\u22121.20); viral non\u2010suppression (7.7% vs. 9.7%, aRR 0.79 95% CI: 0.54\u22121.16) and antiretroviral therapy adherence (92.8% vs. 94.6%, aRR 0.98 95% CI: 0.94\u22121.02) were similar between arms. AYLHIV in the intervention arm received more fast\u2010track visits (aRR 1.21, 95% CI: 1.01\u22121.46). Intervention facilities experienced fewer scheduled appointments compared to control (aRR: 0.95, 95% CI: 0.91\u22120.98, <jats:italic>p<\/jats:italic> = 0.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall, missed visits and non\u2010suppression were infrequent (&lt;\u00a010%) and did not decrease with the DiSC intervention. The DiSC intervention resulted in increased assignment to differentiated services without increasing missed visits or viral non\u2010suppression.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26501","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T10:37:12Z","timestamp":1751884632000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Data\u2010informed Stepped Care (DiSC) to improve adolescent and young adult HIV care outcomes in Kenya: a cluster randomized trial"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6176-6374","authenticated-orcid":false,"given":"Pamela","family":"Kohler","sequence":"first","affiliation":[{"name":"University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0579-9443","authenticated-orcid":false,"given":"Wenwen","family":"Jiang","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacinta","family":"Badia","sequence":"additional","affiliation":[{"name":"IMPACT Research and Development Organization  Kisumu Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Kibugi","sequence":"additional","affiliation":[{"name":"IMPACT Research and Development Organization  Kisumu Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Dyer","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Kadima","sequence":"additional","affiliation":[{"name":"IMPACT Research and Development Organization  Kisumu Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothy","family":"Oketch","sequence":"additional","affiliation":[{"name":"IMPACT Research and Development Organization  Kisumu Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Beima\u2010Sofie","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9323-3214","authenticated-orcid":false,"given":"Sarah","family":"Hicks","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbra A.","family":"Richardson","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Inwani","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle Washington USA"},{"name":"Kenyatta National Hospital  Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seema K.","family":"Shah","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Lurie Children's Hospital  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kawango","family":"Agot","sequence":"additional","affiliation":[{"name":"IMPACT Research and Development Organization  Kisumu Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"John\u2010Stewart","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Institute for Health Metrics and Evaluation (IHME).GBD results.Seattle WA:University of Washington;2024."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0276411"},{"key":"e_1_2_11_4_1","unstructured":"UNAIDS.The path that ends AIDS: 2023 Global AIDS Update.2023. 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