Institut national d'études démographiques (INED), Paris, France.
Phayao Provincial Hospital, Phayao, Thailand.
BMC Public Health. 2021 Jan 21;21(1):189. doi: 10.1186/s12889-021-10189-x.
Adolescents living with perinatal HIV often experience difficult living circumstances that can impact educational achievement and thus their transition to adult life. We explored their school trajectories and evaluated the contribution of perinatal HIV-infection, in Thailand, where education is free and compulsory until the age of 15.
We used data from the Teens Living with Antiretrovirals (TEEWA) study, a cross-sectional case-control study conducted from 2011 to 2014 in Thailand. Participants were 707 adolescents living with perinatal HIV (ALPHIV, cases) aged 12-19 receiving antiretroviral therapy in 19 hospitals throughout Thailand and 689 HIV-uninfected adolescents (controls) living in the same institutions or, for those living in family settings, randomly selected from the general population and individually matched for sex, age, and place of residence. School trajectory disruption was defined as ≥1 year of academic delay or as early school dropout (before 15 years of age). Logistic regression models were used to assess factors independently associated with disrupted school trajectory and to estimate the proportion of school disruption attributable to HIV-infection. We used multivariate imputations by chained equations (MICE) to manage missing data and performed two sensitivity analyses to evaluate the main model's reliability.
The study population's median age was 14.5 years (58% female). School trajectory disruption was experienced by 37% of ALPHIV and 12% of the controls. After adjusting for sociodemographic factors, ALPHIV were 5 times more likely to experience disruption than controls (OR =5.2 [3.7-7.2]). About 50% of school trajectory disruption was attributable to HIV-infection. Males and adolescents living in institutions were more likely to experience school trajectory disruption (OR =1.8 [1.3-2.4] and OR =11.0 [7.7-15.8], respectively). Among ALPHIV, neurocognitive difficulties and growth delay were significantly associated with disruption (OR =3.3 [2.1-5.2] and OR =1.8 [1.3-2.6], respectively). For those living in families, disruption was also associated with having a caregiver who had less than a secondary-level education (OR =2.1 [1.1-3.9]) or having experienced stigmatization (OR =1.9 [1.2-3.1]).
HIV and contextual factors combine to aggravate the educational disadvantage among ALPHIV. The impact of this disadvantage on their life prospects, especially regarding access to higher education and professional achievement, should be further explored.
感染围生期 HIV 的青少年通常生活在困难的环境中，这可能会影响他们的教育成就，进而影响他们向成年生活的过渡。我们探讨了他们的学校轨迹，并评估了围生期 HIV 感染的影响，这是在泰国进行的，泰国的教育是免费的，并且是强制性的，直到 15 岁。
我们使用了来自青少年抗逆转录病毒治疗（TEEWA）研究的数据，这是一项在 2011 年至 2014 年期间在泰国进行的横断面病例对照研究。参与者是 707 名感染围生期 HIV（ALPHIV，病例）的青少年，年龄在 12-19 岁之间，正在泰国 19 家医院接受抗逆转录病毒治疗，以及 689 名未感染 HIV 的青少年（对照组），他们居住在相同的机构中，或者对于那些居住在家庭环境中的青少年，他们是从普通人群中随机选择的，并按性别、年龄和居住地进行个体匹配。学业轨迹中断被定义为≥1 年的学业延迟或提前辍学（15 岁之前）。逻辑回归模型用于评估与学业轨迹中断相关的独立因素，并估计因 HIV 感染而导致学业中断的比例。我们使用链方程的多元插补（MICE）来处理缺失数据，并进行了两次敏感性分析，以评估主要模型的可靠性。
研究人群的中位年龄为 14.5 岁（58%为女性）。ALPHIV 中有 37%和对照组中有 12%的人经历了学业轨迹中断。在调整社会人口因素后，ALPHIV 经历学业轨迹中断的可能性是对照组的 5 倍（OR=5.2 [3.7-7.2]）。大约 50%的学业轨迹中断归因于 HIV 感染。男性和居住在机构中的青少年更有可能经历学业轨迹中断（OR=1.8 [1.3-2.4]和 OR=11.0 [7.7-15.8]）。在 ALPHIV 中，神经认知困难和生长迟缓与中断显著相关（OR=3.3 [2.1-5.2]和 OR=1.8 [1.3-2.6]）。对于那些居住在家庭中的青少年，中断也与照顾者的教育程度低于中学（OR=2.1 [1.1-3.9]）或经历过污名化（OR=1.9 [1.2-3.1]）有关。
HIV 和背景因素共同加剧了 ALPHIV 的教育劣势。这种劣势对他们的生活前景的影响，特别是在获得高等教育和职业成就方面，应该进一步探讨。
