MacPherson Peter, Munthali Chigomezgo, Ferguson Jane, Armstrong Alice, Kranzer Katharina, Ferrand Rashida A, Ross David A
Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Trop Med Int Health. 2015 Aug;20(8):1015-32. doi: 10.1111/tmi.12517. Epub 2015 May 13.
Adolescents living with HIV face substantial difficulties in accessing HIV care services and have worse treatment outcomes than other age groups. The objective of this review was to evaluate the effectiveness of service delivery interventions to improve adolescents' linkage from HIV diagnosis to antiretroviral therapy (ART) initiation, retention in HIV care and adherence to ART.
We systematically searched the Medline, SCOPUS and Web of Sciences databases and conference abstracts from the International AIDS Conference and International Conference on AIDS and STIs in Africa (ICASA). Studies published in English between 1st January 2001 and 9th June 2014 were included. Two authors independently evaluated reports for eligibility, extracted data and assessed methodological quality using the Cochrane risk of bias tool and Newcastle-Ottawa Scale.
Eleven studies from nine countries were eligible for review. Three studies were randomised controlled trials. Interventions assessed included individual and group counselling and education; peer support; directly observed therapy; financial incentives; and interventions to improve the adolescent-friendliness of clinics. Most studies were of low to moderate methodological quality.
This review identified limited evidence on the effectiveness of service delivery interventions to support adolescents' linkage from HIV diagnosis to ART initiation, retention on ART and adherence to ART. Although recommendations are qualified because of the small numbers of studies and limited methodological quality, offering individual and group education and counselling, financial incentives, increasing clinic accessibility and provision of specific adolescent-tailored services appear promising interventions and warrant further investigation.
感染艾滋病毒的青少年在获得艾滋病毒护理服务方面面临巨大困难，其治疗效果也比其他年龄组更差。本综述的目的是评估服务提供干预措施在改善青少年从艾滋病毒诊断到开始抗逆转录病毒治疗（ART）的衔接、在艾滋病毒护理中的留存率以及对ART的依从性方面的有效性。
我们系统检索了Medline、SCOPUS和科学网数据库以及国际艾滋病大会和非洲艾滋病与性传播感染国际会议（ICASA）的会议摘要。纳入2001年1月1日至2014年6月9日期间以英文发表的研究。两位作者独立评估报告的 eligibility，提取数据，并使用Cochrane偏倚风险工具和纽卡斯尔 - 渥太华量表评估方法学质量。
来自9个国家的11项研究符合综述要求。3项研究为随机对照试验。评估的干预措施包括个体和团体咨询与教育；同伴支持；直接观察治疗；经济激励；以及改善诊所对青少年友好程度的干预措施。大多数研究的方法学质量为低到中等。
本综述发现，关于服务提供干预措施在支持青少年从艾滋病毒诊断到开始ART、在ART上的留存率以及对ART的依从性方面有效性的证据有限。尽管由于研究数量少和方法学质量有限，建议存在局限性，但提供个体和团体教育与咨询、经济激励、提高诊所可及性以及提供针对青少年的特定服务似乎是有前景的干预措施，值得进一步研究。
