PROJECT SUMMARY/ABSTRACT The overall goal of the proposed K43 Emerging Global Leader Award (non-clinical trials requirement) is to support Dr. Njuguna’s research training to develop an independent career in HIV research. Dr. Njuguna is a research scientist at the Kenyatta National Hospital, Nairobi, Kenya. The proposed work examines the unique intersection between education and health in the context of adolescent HIV. Dr. Njuguna’s training goals are to gain expertise in human centered design for intervention development, implementation science (IS), mixed methods and adolescent research. This work will also provide an opportunity to work closely with policy makers, and link clinical epidemiology skills she has previously acquired with real world IS methods. The proposal leverages a multidisciplinary team of mentors and collaborators who will ultimately support Dr. Njuguna’s goal to become a productive and influential independent investigator in adolescent HIV research. The research goal of this proposal is to use a human centered design approach by utilizing mixed methods research to gain an in-depth understanding of the school environment and its contribution to achieving treatment goals, and to collaboratively and iteratively develop a school-based intervention to improve outcomes among school-going adolescents living with HIV (ALWHIV). There is a growing population of ALWHIV surviving to adulthood. These children need support to sustain medication use during adolescence and across school and life transitions. There is limited evidence on school-based interventions to support treatment, despite the fact that most ALWHIV are enrolled in school (including boarding schools). The Aims of this proposal are: 1.To evaluate existing school-based structures available for ALWHIV and key determinants of caregiver and ALWHIV school choice decisions, 2.To determine school-related correlates of viral suppression and retention in care, 3.To develop and pilot a school staff training and peer support intervention in selected schools for non-health outcomes (acceptability, feasibility and appropriateness). This is the first study to our knowledge to propose to quantitatively characterize school-related correlates of clinical outcomes in sub-Sahara Africa (SSA) and evaluate factors influencing school choice for ALWHIV. The study brings together a diverse team of stakeholders from the Kenyan national Education and Health sectors and utilizes a multi-step approach to achieve study objectives. This approach will allow for rigorous intervention development process, and pave way for a strong collaborative effort in a future R01 to test effectiveness of a school-based intervention package to improve outcomes, including viral suppression, in school-going ALWHIV, that could potentially benefit adolescents with other non-HIV chronic illnesses. Dr. Njuguna’s research goals correspond with her training goals, and at the completion of this award, she will be in an excellent position to submit an R01 application to further advance research in ALWHIV.

PROJECT NARRATIVE In 2017, an estimated 101,000 Kenyan adolescents aged 10-19 were living with HIV, the majority of whom are enrolled in school. Schools provide unparalleled access to adolescents, are critical for shaping long term health and life trajectories, and could be leveraged to support achievement of treatment goals. We propose a human centered design approach to gain an in-depth understanding of the school environment and its contribution to treatment goals, develop a school based intervention and pilot it for non-health outcomes (acceptability, feasibility and appropriateness), which aligns with the NIH K43 PAR non-clinical trials requirement.