Department of Health Policy and Management, UCLA Fielding School of Public Health, Campus Box 951772, Los Angeles, CA, 90095-1772, USA.
Partners in Hope, Lilongwe, Malawi.
AIDS Behav. 2019 Sep;23(9):2629-2633. doi: 10.1007/s10461-019-02580-y.
To improve outcomes among HIV-positive adolescents, the Malawi Ministry of Health is supporting scale-up of "Teen Clubs," a facility-based antiretroviral treatment (ART) delivery model. Teen Clubs are monthly ART clinics for adolescents (10-19 years old) that provide clinical services and peer psychosocial support. This paper assesses ART adherence among Teen Club attendees in Malawi. We performed a retrospective analysis of medical records and Teen Club attendance data on 589 HIV-positive adolescents at 16 Partners in Hope (PIH)-Extending Quality Improvement for HIV/AIDS in Malawi (EQUIP) supported facilities across Malawi, from January to June of 2017, who attended at least two Teen Club sessions. Multi-level logistic regression models were used to examine the role of gender and age on optimal ART adherence (≥ 95% based on pill count) among HIV-positive adolescents enrolled in Teen Clubs. The median age of adolescents in this sample was 14 years, and 47% were male. Older adolescent males (15-19 years) were 64% more likely to achieve ≥ 95% ART adherence (aOR 1.64, 95% CI 1.16-2.31, p < 0.01) compared to younger (10-14 years) males. The effect of age on adherence was smaller and not significant among females (aOR 1.36, 95% CI 0.96-1.94, p = 0.08). In the full model including males and females, older adolescence was associated with higher odds of optimal adherence (aOR 1.48, 95% CI 1.16-1.90, p < 0.01). These results reinforce the need for age-specialized programming for adolescents, and future research should evaluate this in achieving optimal ART adherence.
为改善艾滋病毒阳性青少年的治疗效果，马拉维卫生部正在支持扩大“青少年俱乐部”的规模，这是一种以机构为基础的抗逆转录病毒治疗（ART）提供模式。青少年俱乐部是一个每月为青少年（10-19 岁）提供临床服务和同伴心理社会支持的抗逆转录病毒治疗（ART）诊所。本文评估了马拉维青少年俱乐部参与者的 ART 依从性。我们对 2017 年 1 月至 6 月期间在 16 个由 Partners in Hope（PIH）支持的希望扩大马拉维艾滋病毒/艾滋病质量改进（EQUIP）的医疗机构中接受至少两次青少年俱乐部治疗的 589 名艾滋病毒阳性青少年的医疗记录和青少年俱乐部出勤数据进行了回顾性分析。多水平逻辑回归模型用于研究性别和年龄对参加青少年俱乐部的艾滋病毒阳性青少年最佳 ART 依从性（根据药片计数≥95%）的作用。该样本中青少年的中位年龄为 14 岁，其中 47%为男性。年龄较大的青少年男性（15-19 岁）比年龄较小的男性（10-14 岁）实现≥95%ART 依从性的可能性高 64%（调整后的比值比 1.64，95%可信区间 1.16-2.31，p<0.01）。在女性中，年龄对依从性的影响较小且无统计学意义（调整后的比值比 1.36，95%可信区间 0.96-1.94，p=0.08）。在包括男性和女性的全模型中，青少年晚期与更高的最佳依从性几率相关（调整后的比值比 1.48，95%可信区间 1.16-1.90，p<0.01）。这些结果强调了为青少年制定专门的年龄方案的必要性，未来的研究应该评估这一方案在实现最佳 ART 依从性方面的效果。
