Saberi Parya, Dawson Rose Carol, Wootton Angie R, Ming Kristin, Legnitto Dominique, Jeske Melanie, Pollack Lance M, Johnson Mallory O, Gruber Valerie A, Neilands Torsten B
Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.
Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.
AIDS Care. 2020 Aug;32(8):931-939. doi: 10.1080/09540121.2019.1622637. Epub 2019 May 28.
Disparities in HIV treatment outcomes among youth living with HIV (YLWH) present a challenge for ending the HIV epidemic. Antiretroviral therapy (ART) adherence can be impacted by comorbidities such as mental health and substance use. Technology use has shown promise in increasing access to mental health and substance use services. Using a mixed-methods approach, we conducted formative research to describe the relationship between mental health, substance use, and medication adherence in 18-29 year-old YLWH, and explored technology use as an approach to supporting these services. Among 101 YLWH, ART adherence was significantly negatively associated with mental health measures such as depression, trauma, and adverse childhood experiences and marijuana and stimulants use. Depression had the highest level of relative importance in its association with ART adherence. During in-depth interviews with 29 participants, barriers to and facilitators of accessing and maintaining mental health services were identified. Most participants favored technology use for mental health and substance use service delivery, including videoconferencing with a counselor. Provision of ongoing mental health and substance use treatment is an important mechanism to achieving HIV treatment engagement. Technology, particularly videoconferencing, may have the capacity to overcome many barriers to care by increasing accessibility of these services.
感染艾滋病毒的青年（YLWH）在艾滋病毒治疗结果方面存在的差异，对终结艾滋病毒流行构成了挑战。抗逆转录病毒疗法（ART）的依从性可能会受到心理健康和物质使用等合并症的影响。技术应用已显示出在增加获得心理健康和物质使用服务机会方面的前景。我们采用混合方法进行了形成性研究，以描述18至29岁的感染艾滋病毒青年中心理健康、物质使用与药物依从性之间的关系，并探索将技术应用作为支持这些服务的一种方式。在101名感染艾滋病毒青年中，抗逆转录病毒疗法的依从性与抑郁、创伤和不良童年经历以及大麻和兴奋剂使用等心理健康指标显著负相关。抑郁在与抗逆转录病毒疗法依从性的关联中具有最高的相对重要性。在对29名参与者进行的深入访谈中，确定了获得和维持心理健康服务的障碍及促进因素。大多数参与者赞成使用技术来提供心理健康和物质使用服务，包括与咨询师进行视频会议。提供持续的心理健康和物质使用治疗是促进艾滋病毒治疗参与的重要机制。技术，尤其是视频会议，可能有能力通过增加这些服务的可及性来克服许多护理障碍。
