Munyayi Farai K, van Wyk Brian
School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
International Training and Education Center for Health, Windhoek, Namibia.
South Afr J HIV Med. 2020 Feb 3;21(1):1031. doi: 10.4102/sajhivmed.v21i1.1031. eCollection 2020.
BACKGROUND: Adolescents living with HIV (ALHIV) are notably underserved by the national HIV programmes globally because of their unique needs. Of particular concern is limited access to and availability of adolescent-friendly antiretroviral therapy (ART) services, which contribute to poor retention in care in many sub-Saharan African countries. A Teen Club intervention was introduced in 2010 in Windhoek, Namibia, to improve retention in care among ALHIV through psychosocial support in a peer-group environment. OBJECTIVES: To compare the effects of the Teen Club intervention against standard care on retention in HIV care amongst adolescents at a Paediatric ART clinic. METHOD: A retrospective cohort analysis of adolescents aged 10-19 years receiving ART between July 2015 and June 2017 was conducted. Routine patient data were extracted from an electronic database and patient registers. A sample of 385 participants was analysed: 78 in the Teen Club and 307 in standard care. Retention was measured by assessing attendance to prescribed clinic visits up to 24 months. Comparisons were assessed with the Chi-square test, and Kaplan-Meier survival analysis was conducted to analyse differences in retention rates. RESULTS: The overall retention rate at 24 months among all adolescents was 90.1%, with no statistically significant difference between those in Teen Club (91%) and those in standard care (89%) ( = 0.956). Younger adolescents (10-14 years) had better retention rates at 24 months compared to older adolescents (15-19 years) (94% vs. 86%; = 0.016). Retention rates were significantly higher for adolescents on first-line ART regimen (vs. second line: hazard ratio [HR] = 0.333; 95% confidence interval [CI] = 0.125-0.889); on ART ≥ 12 months (vs. < 12 months: HR =0.988; 95% CI = 0.977-0.999); and those to whom their HIV status was disclosed (HR = 0.131; 95% CI = 0.025-0.686). CONCLUSION: Group-based adherence support interventions did not improve retention rates for younger adolescents in specialised paediatric ART clinics but may still hold the potential for improving retention rates of older adolescents.
背景：全球范围内，感染艾滋病毒的青少年（ALHIV）因特殊需求而在国家艾滋病毒防治项目中明显未得到充分服务。特别令人担忧的是，青少年友好型抗逆转录病毒疗法（ART）服务的可及性和可得性有限，这在许多撒哈拉以南非洲国家导致了护理留存率较低。2010年在纳米比亚温得和克引入了青少年俱乐部干预措施，旨在通过在同伴群体环境中提供心理社会支持来提高ALHIV的护理留存率。 目的：比较青少年俱乐部干预措施与标准护理对儿科抗逆转录病毒治疗诊所中青少年艾滋病毒护理留存率的影响。 方法：对2015年7月至2017年6月期间接受抗逆转录病毒治疗的10至19岁青少年进行回顾性队列分析。从电子数据库和患者登记册中提取常规患者数据。分析了385名参与者的样本：78名在青少年俱乐部，307名接受标准护理。通过评估长达24个月的规定诊所就诊出勤率来衡量留存率。使用卡方检验进行比较，并进行Kaplan-Meier生存分析以分析留存率的差异。 结果：所有青少年在24个月时的总体留存率为90.1%，青少年俱乐部的参与者（91%）和接受标准护理的参与者（89%）之间无统计学显著差异（P = 0.956）。与年龄较大的青少年（15 - 19岁）相比，年龄较小的青少年（10 - 14岁）在24个月时的留存率更高（94%对86%；P = 0.016）。接受一线抗逆转录病毒治疗方案的青少年的留存率显著更高（与二线治疗相比：风险比[HR] = 0.333；95%置信区间[CI] = 0.125 - 0.889）；接受抗逆转录病毒治疗≥12个月的青少年（与< 12个月相比：HR = 0.988；95% CI = 0.977 - 0.999）；以及其艾滋病毒感染状况已被告知的青少年（HR = 0.131；95% CI = 0.025 - 0.686）。 结论：基于群体的依从性支持干预措施并未提高专门儿科抗逆转录病毒治疗诊所中年龄较小青少年的留存率，但可能仍有提高年龄较大青少年留存率的潜力。
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