PROJECT SUMMARY/ABSTRACT The purpose of the Suubi+Adherence-R2 administrative supplemental project is to enhance inclusion of the target population by recruiting refugee youth living with HIV (RYLHIV) in Uganda. While the parent grant focuses on youth living with HIV, it does not include refugee youth population. Yet, refugee youth are a very vulnerable population at increased risk of HIV infection due to exploitation as many of them may be unaccompanied by parents or guardians and many have been exposed to gender-based violence including rape that is used as a weapon of war in the conflicts they are fleeing from. Moreover, many of these refugees are now settled in areas with some of the highest HIV rates in Uganda. This elevated risk of HIV infection among the refugee population is compounded by the fact that many of these refugee youth have very limited knowledge about sexual and reproductive health in general. Additionally, HIV testing rates are low in these refugee communities due to barriers such as lack of privacy from overcrowding in camps, transportation difficulties, literacy and language difficulties, stigma, and HIV testing is often not the top priority as refugees are preoccupied by activities necessary for basic survival. Additionally, given the high prevalence of trauma-associated mental disorders due to their exposure to trauma, compounded by the abject poverty that they have been thrown into by displacement, that have been shown to increase the rates of engagement in risky sexual behavior and substance use, these adolescent refugees are at especially increased risk of acquiring or transmitting HIV and other STIs. Consistent with the aims of the parent grant, the administrative supplement will allow us to: examine the HIV viral suppression (primary outcome) and explore the participants' ability to access and refill prescribed medication, adhere to prescribed daily medication routines, and engage in HIV care; and (2) assess a) economic stability, sexual risk- taking behavior, adherence self-efficacy; b) cognitive functioning; c) mental health functioning; and d) young adult transitions and social support. This administrative supplement is significant because it has the potential to advance our understanding of factors including utilization of HIV treatment and adherence to treatment, trauma-associated disorders, psychological functioning, and sexual decision-making among vulnerable refugee youth population in Uganda.

PROJECT NARRATIVE Refugee youth in Uganda are at increased risk of both HIV transmission and infection due to a number of factors including settlement in high HIV prevalence areas, lack of knowledge about sexual and reproductive health in general, limited access to life saving Antiretroviral treatment (ART), and mental health challenges from exposure to trauma. While most of the HIV-related research in this area has primarily focused on Ugandan nationals and refugee adults, very little attention has been paid to the refugee youth population located in the same areas with high HIV prevalence. Aligned with the National Institutes of Health Office of AIDS Research priorities, this administrative supplemental project aims to enhance inclusion of the target population by recruiting refugee youth living with HIV (RYLHIV) to understand factors around access to and utilization of HIV treatment and adherence to treatment, trauma-associated disorders, psychological functioning, and sexual decision-making, which will contribute to our understanding of the grave public health threat of HIV among vulnerable refugee youth population in Uganda.