Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island.
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.
AIDS Rev. 2020 Jul 8;22(2):93-102. doi: 10.24875/AIDSRev.20000101.
Older adolescents and young adults (youth) living with HIV (YLH) in sub-Saharan Africa (SSA) are at high risk for poor HIV treatment adherence and associated negative health outcomes including viral nonsuppression. To describe this risk, we conducted a comprehensive review of studies involving YLH. Eligible studies compared youth adherence or adherence-related health functioning to older or younger samples, examined factors associated with adherence or health outcomes among YLH, or evaluated adherence interventions with YLH. Databases searched included MEDLINE, Web of Science, Global Health, CINAHL, Africa-Wide Information, PsycINFO, and the Cochrane Library. Of the 7054 articles found, 156 were reviewed and 130 were eligible. Across 16 adherence-related behaviors or health outcomes such as lost to follow-up, retention in care, antiretroviral use, CD4 count, viral suppression, and mortality, 73% of studies comparing YLH to other age groups (n = 106) found worse outcomes among YLH. In 22 studies, barriers and facilitators to adherence were identified, some unique to YLH (e.g., conflicting treatment expectations of providers) and some common to other age groups. Finally, of the eight adherence interventions with YLH reviewed, five showed evidence of being effective. Our findings suggest that YLH in SSA faces numerous obstacles to engaging in HIV treatment across a range of shifting social contexts. Accounting for this group's transition to treatment self-management, developmentally tailored and holistic interventions should be the focus of adherence promotion efforts.
撒哈拉以南非洲（SSA）的成年青少年和年轻成年人（YLH）艾滋病毒（HIV）感染者面临着较差的 HIV 治疗依从性以及相关的负面健康结果（包括病毒未被抑制）的高风险。为了描述这种风险，我们对涉及 YLH 的研究进行了全面审查。合格的研究将青年的依从性或与依从性相关的健康功能与年龄较大或较小的样本进行了比较，研究了与 YLH 的依从性或健康结果相关的因素，或者评估了针对 YLH 的依从性干预措施。搜索的数据库包括 MEDLINE、Web of Science、全球健康、CINAHL、非洲信息广泛、PsycINFO 和 Cochrane Library。在发现的 7054 篇文章中，有 156 篇进行了审查，有 130 篇符合条件。在 16 项与依从性相关的行为或健康结果（例如失访、护理保留、抗逆转录病毒药物使用、CD4 计数、病毒抑制和死亡率）中，比较 YLH 与其他年龄组（n = 106）的 73%的研究发现 YLH 的结果更差。在 22 项研究中，确定了依从性的障碍和促进因素，其中一些是 YLH 特有的（例如提供者的治疗期望冲突），而另一些则是其他年龄组共有的。最后，在对 YLH 进行的八项依从性干预措施的审查中，有五项显示出有效的证据。我们的研究结果表明，SSA 的 YLH 在一系列不断变化的社会背景下，在参与 HIV 治疗方面面临着许多障碍。考虑到该人群向治疗自我管理的转变，应将针对其的量身定制和整体干预措施作为促进依从性的重点。
