Munyayi Farai K, van Wyk Brian E
University of the Western Cape, Cape Town, South Africa.
AIDS Res Treat. 2020 Oct 27;2020:8604276. doi: 10.1155/2020/8604276. eCollection 2020.
Adolescents living with HIV (ALHIV) are challenged to adhere to antiretroviral therapy (ART) and achieve and maintain virologic suppression. Group-based adherence support interventions, such as adherence clubs, have been shown to improve long-term adherence in ART patients. The teen club intervention was introduced in 2010 in Namibia to improve treatment outcomes for ALHIV by providing adherence support in a peer-group environment. Adolescents who have completed the full HIV disclosure process can voluntarily join the teen clubs. The current study compared treatment outcomes of ALHIV receiving ART at a specialized paediatric HIV clinic between 1 July 2015 and 30 June 2017 in Windhoek, Namibia.
A retrospective cohort analysis was conducted on routine patient data extracted from the electronic Patient Monitoring System, individual Patient Care Booklets, and teen club attendance registers. A sample of 385 adolescents were analysed: 78 in teen clubs and 307 in standard care. Virologic suppression was determined at 6, 12, and 18 months from study start date, and compared by model of care, age, sex, disclosure status, and ART regimen. Comparisons between adolescents in teen clubs and those receiving standard care were performed using the chi-square test, and risk ratios were calculated to analyze differences in ART adherence and virologic suppression.
The average clinician-measured ART adherence was 89% good, 6% fair, and 5% poor amongst all adolescents, with no difference between teen club members and adolescents in standard care ( = 0.277) at 3 months. Virologic suppression over the 2-year observation period was 87% (68% fully suppressed <40 copies/ml and 19% suppressed between 40-999 copies/ml), with no difference between teen club members and those in standard care. However, there were statistically significant differences in virologic suppression levels between the younger (10-14 years) adolescents and older (15-19 years) adolescents at 6 months ( = 0.015) and at 12 months ( = 0.021) and between adolescents on first-line and second-line ART regimen at 6 months ( = 0.012), 12 months ( = 0.004), and 18 months ( = 0.005).
The teen club model delivering psychosocial support only did not improve adherence and virologic suppression levels for adolescents in a specialized paediatric ART clinic, neither were they inferior to standard care. Considering the limitations of this study, teen clubs may still hold potential for improving adherence and virologic suppression levels for older adolescents, and more robust research on adherence interventions for adolescents with higher methodological quality is required.
感染艾滋病毒的青少年（ALHIV）在坚持抗逆转录病毒疗法（ART）以及实现并维持病毒学抑制方面面临挑战。基于群体的依从性支持干预措施，如依从性俱乐部，已被证明可提高接受抗逆转录病毒治疗患者的长期依从性。2010年在纳米比亚引入了青少年俱乐部干预措施，通过在同伴群体环境中提供依从性支持来改善感染艾滋病毒青少年的治疗效果。已完成完整艾滋病毒披露过程的青少年可自愿加入青少年俱乐部。本研究比较了2015年7月1日至2017年6月30日期间在纳米比亚温得和克一家专门的儿科艾滋病毒诊所接受抗逆转录病毒治疗的感染艾滋病毒青少年的治疗效果。
对从电子患者监测系统、个人患者护理手册和青少年俱乐部出勤登记册中提取的常规患者数据进行回顾性队列分析。分析了385名青少年样本：78名在青少年俱乐部，307名接受标准护理。从研究开始日期起6个月、12个月和18个月时确定病毒学抑制情况，并按护理模式、年龄、性别、披露状态和抗逆转录病毒治疗方案进行比较。使用卡方检验对青少年俱乐部中的青少年与接受标准护理的青少年进行比较，并计算风险比以分析抗逆转录病毒治疗依从性和病毒学抑制的差异。
在所有青少年中，临床医生测量的抗逆转录病毒治疗平均依从性为良好89%、一般6%、差5%，在3个月时青少年俱乐部成员与接受标准护理的青少年之间无差异（P = 0.277）。在2年观察期内病毒学抑制率为87%（68%完全抑制<40拷贝/毫升，19%抑制在40 - 999拷贝/毫升之间），青少年俱乐部成员与接受标准护理的青少年之间无差异。然而，在6个月（P = 0.015）和12个月（P = 0.021）时，年龄较小（10 - 14岁）的青少年与年龄较大（15 - 19岁）的青少年之间以及在6个月（P = 0.012）、12个月（P = 0.004）和18个月（P = 0.005）时接受一线和二线抗逆转录病毒治疗方案的青少年之间，病毒学抑制水平存在统计学显著差异。
仅提供心理社会支持的青少年俱乐部模式并未提高专门儿科抗逆转录病毒治疗诊所中青少年的依从性和病毒学抑制水平，它们也不低于标准护理。考虑到本研究的局限性，青少年俱乐部可能仍有提高年龄较大青少年依从性和病毒学抑制水平的潜力，并且需要对方法学质量更高的青少年依从性干预措施进行更有力研究。
