Smith Fawzi Mary C, Ng Lauren, Kanyanganzi Fredrick, Kirk Catherine, Bizimana Justin, Cyamatare Felix, Mushashi Christina, Kim Taehoon, Kayiteshonga Yvonne, Binagwaho Agnes, Betancourt Theresa S
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;
Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Pediatrics. 2016 Oct;138(4). doi: 10.1542/peds.2015-3235.
In Rwanda, significant progress has been made in advancing access to antiretroviral therapy (ART) among youth. As availability of ART increases, adherence is critical for preventing poor clinical outcomes and transmission of HIV. The goals of the study are to (1) describe ART adherence and mental health problems among youth living with HIV aged 10 to 17; and (2) examine the association between these factors among this population in rural Rwanda.
A cross-sectional analysis was conducted that examined the association of mental health status and ART adherence among youth (n = 193). ART adherence, mental health status, and related variables were examined based on caregiver and youth report. Nonadherence was defined as ever missing or refusing a dose of ART within the past month. Multivariate modeling was performed to examine the association between mental health status and ART adherence.
Approximately 37% of youth missed or refused ART in the past month. In addition, a high level of depressive symptoms (26%) and attempt to hurt or kill oneself (12%) was observed in this population of youth living with HIV in Rwanda. In multivariate analysis, nonadherence was significantly associated with some mental health outcomes, including conduct problems (odds ratio 2.90, 95% confidence interval 1.55-5.43) and depression (odds ratio 1.02, 95% confidence interval 1.01-1.04), according to caregiver report. A marginally significant association was observed for youth report of depressive symptoms.
The findings suggest that mental health should be considered among the factors related to ART nonadherence in HIV services for youth, particularly for mental health outcomes, such as conduct problems and depression.
在卢旺达，青少年获得抗逆转录病毒疗法（ART）方面已取得显著进展。随着ART可及性的提高，坚持治疗对于预防不良临床结局和HIV传播至关重要。本研究的目标是：（1）描述10至17岁HIV感染青少年的ART治疗依从性和心理健康问题；（2）在卢旺达农村的这一人群中研究这些因素之间的关联。
进行了一项横断面分析，研究了青少年（n = 193）的心理健康状况与ART治疗依从性之间的关联。根据照顾者和青少年的报告，对ART治疗依从性、心理健康状况及相关变量进行了研究。不依从被定义为在过去一个月内曾漏服或拒绝服用一剂ART。进行多变量建模以研究心理健康状况与ART治疗依从性之间的关联。
在过去一个月中，约37%的青少年漏服或拒绝服用ART。此外，在卢旺达的这一HIV感染青少年人群中，观察到高水平的抑郁症状（26%）和企图伤害或自杀（12%）。在多变量分析中，根据照顾者报告，不依从与一些心理健康结局显著相关，包括行为问题（比值比2.90，95%置信区间1.55 - 5.43）和抑郁（比值比1.02，95%置信区间1.01 - 1.04）。青少年报告的抑郁症状存在边缘显著关联。
研究结果表明，在针对青少年的HIV服务中，应将心理健康视为与ART治疗不依从相关的因素之一，尤其是对于行为问题和抑郁等心理健康结局。
