Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA 02115, USA.
J Acquir Immune Defic Syndr. 2013 Jul 1;63(3):401-9. doi: 10.1097/QAI.0b013e318293ad53.
Obtaining accurate estimates of mental health problems among youth perinatally infected with HIV (PHIV) helps clinicians develop targeted interventions but requires enrollment and retention of representative youth into research studies.
The study design for IMPAACT P1055, a US-based, multisite prospective study of psychiatric symptoms among PHIV youth and uninfected controls aged 6 to 17 years old, is described. Participants were compared with nonparticipants by demographic characteristics and reasons were summarized for study refusal. Adjusted logistic regression models were used to evaluate the association of psychiatric symptoms and other factors with loss to follow-up (LTFU).
Among 2281 youth screened between 2005 and 2006 at 29 IMPAACT research sites, 580 (25%) refused to participate, primarily because of time constraints. Among 1162 eligible youth approached, 582 (50%) enrolled (323 PHIV and 259 Control), with higher participation rates for Hispanic youth. Retention at 2 years was significantly higher for PHIV than Controls (84% vs 77%, P = 0.03). In logistic regression models adjusting for sociodemographic characteristics and HIV status, youth with any self-assessed psychiatric condition had higher odds of LTFU compared with those with no disorder (adjusted odds ratio = 1.56, 95% confidence interval: 1.00 to 2.43). Among PHIV youth, those with any psychiatric condition had 3-fold higher odds of LTFU (adjusted odds ratio = 3.11, 95% confidence interval: 1.61 to 6.01).
Enrollment and retention of PHIV youth into mental health research studies is challenging for those with psychiatric conditions and may lead to underestimated risks for mental health problems. Creative approaches for engaging HIV-infected youth and their families are required for ensuring representative study populations.
准确评估围产期感染 HIV（PHIV）的青少年的心理健康问题有助于临床医生制定有针对性的干预措施，但需要招募并保留有代表性的青少年参与研究。
描述了 IMPAACT P1055 研究的设计，这是一项在美国进行的、多中心的、针对 PHIV 青少年和未感染对照者（年龄 6 至 17 岁）精神症状的前瞻性研究。通过人口统计学特征比较参与者和非参与者，并总结研究拒绝的原因。采用调整后的逻辑回归模型评估精神症状和其他因素与失访（LTFU）的相关性。
在 2005 年至 2006 年期间，在 29 个 IMPAACT 研究点对 2281 名青少年进行筛查，其中 580 名（25%）拒绝参与，主要是因为时间限制。在 1162 名符合条件的青少年中，有 582 名（323 名 PHIV 和 259 名对照者）入组，其中西班牙裔青少年的参与率较高。与对照组相比，PHIV 青少年的 2 年保留率显著更高（84%比 77%，P=0.03）。在调整社会人口统计学特征和 HIV 状况的逻辑回归模型中，任何自我评估的精神疾病的青少年与无疾病的青少年相比，LTFU 的可能性更高（调整后的优势比=1.56，95%置信区间：1.00 至 2.43）。在 PHIV 青少年中，任何精神疾病的青少年 LTFU 的可能性增加 3 倍（调整后的优势比=3.11，95%置信区间：1.61 至 6.01）。
对于有精神疾病的 PHIV 青少年，将其招募并纳入心理健康研究具有挑战性，这可能导致对心理健康问题的风险低估。需要采用创造性的方法来吸引感染 HIV 的青少年及其家庭，以确保研究人群具有代表性。
