St John's College of Nursing and Midwifery, P.O Box 18, Mzuzu, Malawi.
Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu 2, Malawi.
Reprod Health. 2018 Oct 24;15(1):180. doi: 10.1186/s12978-018-0614-4.
BACKGROUND: Adolescents living with HIV (ALWHIV) in sub-Saharan Africa encounter multiple health problems that are often unrecognised by the public and the healthcare workforce. The aim of this systematic review was to identify risky health behaviours and their associated factors among ALWHIV in sub-Saharan Africa. METHODS: We systematically searched for articles in Medline, SCOPUS, Directory of Open Access Journals, Science Direct, ProQuest, Psych-info, Web of science, WHO Global Index Medicus library, Cochrane, and Google Scholar. Studies were included in this review if: they were original studies; participants were aged from 10 to 19 years; participants were ALWHIV or they had data from different key informants focusing on ALWHIV within the age group; they had health behaviours as an outcome; they were conducted in sub-Saharan Africa and were published before December 2016. Data were extracted and the quality of the studies was appraised using the Mixed Method Appraisal Tool (MMAT). RESULTS: Thirty-six studies met the eligibility criteria. Nineteen studies scored 100% (indicating high quality), sixteen studies scored 75% (indicating moderate quality) and one study scored 50% (indicating low quality) on the MMAT scale. Adherence to antiretroviral therapy among ALWHIV was suboptimal and was negatively affected by forgetfulness, opportunistic infection, long distance to clinics, and fear of unplanned disclosure. Many adolescents were sexually active, but the majority did not disclose their HIV status to sexual partners, despite knowing their diagnosis (range 76-100% across available studies) and some did not use protection (condoms) to prevent transmission of HIV and other sexually transmitted diseases (range 35-55%). Disclosure to and from adolescents was low across the studies and was associated with fear of disclosure aftermaths including stigma and discrimination (range 40-57%). CONCLUSION: A considerable proportion of ALWHIV in sub-Saharan Africa engage in multiple risky health behaviours, which have a substantial negative impact on their wellbeing and cause significant risk and burden to their families, sexual partners and societies.
背景：撒哈拉以南非洲的青少年艾滋病毒感染者（ALWHIV）面临多种健康问题，但这些问题常常未被公众和医疗保健人员所认识。本系统评价的目的是确定撒哈拉以南非洲 ALWHIV 的危险健康行为及其相关因素。
方法：我们系统地在 Medline、SCOPUS、开放获取期刊目录、Science Direct、ProQuest、Psych-info、Web of science、世界卫生组织全球医学索引图书馆、Cochrane 和 Google Scholar 中搜索文章。如果符合以下标准，则将研究纳入本综述：原始研究；参与者年龄在 10 至 19 岁之间；参与者为 ALWHIV 或有来自不同主要信息来源的数据，这些信息来源主要关注该年龄组内的 ALWHIV；有健康行为作为结果；在撒哈拉以南非洲进行，且在 2016 年 12 月之前发表。使用混合方法评估工具（MMAT）提取数据并评估研究质量。
结果：36 项研究符合入选标准。19 项研究在 MMAT 量表上得分为 100%（表示高质量），16 项研究得分为 75%（表示中等质量），1 项研究得分为 50%（表示低质量）。ALWHIV 的抗逆转录病毒治疗依从性不理想，受到健忘、机会性感染、到诊所的距离长和对意外披露的恐惧等因素的负面影响。许多青少年有性行为，但大多数人没有向性伴侣透露自己的 HIV 状况，尽管他们知道自己的诊断（在可用研究中范围为 76-100%），而且有些人没有使用保护措施（避孕套）来预防 HIV 和其他性传播疾病的传播（范围为 35-55%）。在研究中，青少年之间的披露率较低，且与披露后果有关，包括耻辱感和歧视（范围为 40-57%）。
结论：撒哈拉以南非洲相当一部分 ALWHIV 存在多种危险的健康行为，这些行为对他们的幸福感产生了重大负面影响，并对他们的家庭、性伴侣和社会造成了重大风险和负担。
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