项目 YES！青年参与成功：一项基于诊所的同伴辅导计划对赞比亚恩多拉 HIV 阳性青年（15-24 岁）病毒抑制、依从性和内化耻辱感影响的随机对照试验。

Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15-24 years) in Ndola, Zambia.

机构信息

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

Arthur Davison Children's Hospital, Ndola, Zambia.

出版信息

PLoS One. 2020 Apr 2;15(4):e0230703. doi: 10.1371/journal.pone.0230703. eCollection 2020.

DOI:10.1371/journal.pone.0230703

PMID:32240186

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7117673/

Abstract

BACKGROUND

Youth-led strategies remain untested in clinic-based programs to improve viral suppression (VS) and reduce stigma among HIV-positive adolescents and young adults (AYA) in sub-Saharan Africa. In response, Project YES! placed paid HIV-positive youth peer mentors (YPM) in four HIV clinics in Ndola, Zambia including a Children's Hospital (pediatric setting), an adult Hospital and two primary care facilities (adult settings).

METHODS

A randomized controlled trial was conducted from December 2017 to February 2019. Consecutively recruited 15 to 24-year-olds were randomly assigned to an intervention arm with monthly YPM one-on-one and group sessions and optional caregiver support groups, or a usual care comparison arm. Survey data and blood samples were collected at baseline and at the six-month midline. Generalized estimating equation models evaluated the effect of study arm over time on VS, antiretroviral treatment (ART) adherence gap, and internalized stigma.

RESULTS

Out of 276 randomized youth, 273 were included in the analysis (Intervention n = 137, Comparison n = 136). VS significantly improved in both arms (I:63.5% to 73.0%; C:63.7% to 71.3.0%) [OR:1.49, 95% CI:1.08, 2.07]. In a stratified analysis intervention (I:37.5% to 70.5%) versus the comparison (C:60.3% to 59.4%) participants from the pediatric clinic experienced a relative increase in the odds of VS by a factor of 4.7 [interaction term OR:4.66, 95% CI:1.84, 11.78]. There was no evidence of a study arm difference in VS among AYA in adult clinics, or in ART adherence gaps across clinics. Internalized stigma significantly reduced by a factor of 0.39 [interaction term OR:0.39, 95% CI:0.21,0.73] in the intervention (50.4% to 25.4%) relative to the comparison arm (45.2% to 39.7%).

CONCLUSIONS

Project YES! engaged AYA, improving VS in the pediatric clinic and internalized stigma in the pediatric and adult clinics. Further research is needed to understand the intersection of VS and internalized stigma among AYA attending adult HIV clinics.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04115813.

摘要

背景

在撒哈拉以南非洲，以青年为主导的策略在以诊所为基础的项目中尚未得到检验，这些项目旨在改善艾滋病毒阳性青少年和年轻人（AYA）的病毒抑制（VS）水平并减少污名。为此，“是！”项目在赞比亚恩多拉的四家诊所（包括一家儿童医院（儿科环境）、一家成人医院和两家初级保健机构（成人环境））中安置了领薪的艾滋病毒阳性青年同伴导师（YPM）。

方法

这是一项于 2017 年 12 月至 2019 年 2 月进行的随机对照试验。连续招募了 15 至 24 岁的参与者，他们被随机分配到干预组或对照组。干预组接受每月一次的 YPM 一对一和小组会议以及可选的照顾者支持小组，而对照组则接受常规护理。在基线和六个月的中期收集调查数据和血样。广义估计方程模型评估了研究臂随时间推移对 VS、抗逆转录病毒治疗（ART）依从性差距和内化污名的影响。

结果

在 276 名随机分配的年轻人中，有 273 名（干预组 n = 137，对照组 n = 136）纳入了分析。在两个臂中，VS 均显著改善（I：63.5%至 73.0%；C：63.7%至 71.3.0%）[比值比：1.49，95%置信区间：1.08，2.07]。在分层分析中，与对照组（儿科诊所的 C：60.3%至 59.4%）相比，干预组（儿科诊所的 I：37.5%至 70.5%）参与者的 VS 增加的可能性高 4.7 倍[交互项比值比：4.66，95%置信区间：1.84，11.78]。在成人诊所的 AYA 中，或在诊所之间的 ART 依从性差距方面，均未发现研究臂在 VS 方面存在差异。与对照组（45.2%至 39.7%）相比，干预组（50.4%至 25.4%）的内化污名显著降低了 0.39 倍[交互项比值比：0.39，95%置信区间：0.21，0.73]。