Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource-Constrained Settings--Implementation Science Network (PATC3H-IN)

The Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings–Implementation Science Network (PATC3H-IN) conducts implementation science (IS) research on adolescent HIV. PATC3H-IN develops scalable, low-resource care delivery models in low- and middle-income countries that can be adapted for marginalized and high-burden US populations.  It aligns with NIH's Unified Strategy prioritizing IS to expand uptake of and access to HIV interventions.  PATC3H-IN will study and test the impact of implementation strategies on adolescent HIV incidence, prevention uptake, and viral suppression, providing a strong evidence base for interventions that can be used in US-based programs. 

Resource-constrained, high-burden settings outside the US provide an unparalleled environment for adolescent HIV implementation science that aims to strengthen HIV care in the US.  Higher HIV incidence and prevalence allow researchers to rigorously evaluate implementation strategies in large adolescent populations.  The studies produce robust evidence on effectiveness, scalability, adaptation, and sustainability. These studies complement U.S.-based research by generating evidence that is difficult to obtain within the smaller, geographically dispersed population of adolescents living with HIV in the US.  In addition, they test implementation strategies across a wide range of health systems and community settings.

Limited local resources outside the US also drive innovation through necessity. Health systems develop efficient, scalable models of care–including differentiated service delivery, task sharing, peer support, digital adherence interventions, and community-based care–to maximize impact with available resources. Many international HIV programs also operate within coordinated care systems that can rapidly test, adapt, and refine service delivery strategies through continuous, data-driven evaluation. This operational flexibility supports rapid-cycle learning and implementation at a pace that is often difficult to achieve in the more complex and decentralized U.S. healthcare system. Combined with access to large adolescent cohorts, these settings provide an exceptional platform for generating rigorous, practice-ready implementation evidence.

The innovations are directly relevant to the United States, where adolescents and young adults living with HIV are projected to incur nearly $17 billion in lifetime healthcare costs, averaging approximately $685,000 per person. Despite advances in HIV prevention and treatment, nearly 39,000 people receive new HIV diagnoses each year in the United States.  About one in five of these new cases occur among adolescents and young adults, and many individuals still receive their diagnosis at later stages of infection. Many U.S. adolescents affected by HIV face the same barriers as youth in resource-constrained settings, including poverty, housing instability, stigma, transportation challenges, workforce shortages, and fragmented care.  As a result, implementation strategies that succeed in resource-constrained settings can help build more resilient and scalable models of care in the US. Global adolescent HIV implementation research provides critical evidence needed to achieve the goals of the Ending the HIV Epidemic in the U.S. initiative by accelerating the translation of effective, resilient, and cost-conscious models of care into domestic practice.

Adolescents and young people represent a growing share of people living with HIV in the US and worldwide.  Comprising Clinical Research Centers and a Data and Coordinating Center, PATC3H-IN addresses this gap by supporting IS research to prevent HIV acquisition among at-risk adolescents and improve care outcomes for youth living with HIV.  Grant authorities allowing the Eunice Kennedy Shriver National Institute of Child Health and Human Development to forecast this opportunity include: 42 U.S.C. 281 (Sec. 401); 42 U.S.C. 285g (Sec. 448); 42 USC 284h (Sec. 409D).