Population Council, Lusaka, Zambia.
PLoS One. 2021 Jan 22;16(1):e0243822. doi: 10.1371/journal.pone.0243822. eCollection 2021.
Children and youth are profoundly impacted groups in Zambia's HIV epidemic. To evaluate delivery of integrated psychosocial, economic strengthening, and clinical services to HIV-affected households through the Zambia Family (ZAMFAM) Project, a prospective cohort study compared socio-economic, psychosocial, and health outcomes among ZAMFAM beneficiaries to non-beneficiaries.
In July-October 2017, 544 adolescents living with HIV (ALHIV) aged 5-17 years and their adult caregivers were recruited from Central (ZAMFAM implementation sites) and Eastern (non-intervention sites) Provinces. Structured interviews at baseline and one-year follow-up assessed household characteristics, socio-economic wellbeing, and health service utilization. Poisson regression with generalized estimating equations measured one-year changes in key health and socio-economic indicators, comparing ZAMFAM beneficiaries to non-beneficiaries.
Overall, 494 households completed two rounds of assessment (retention rate: 91%) Among ALHIV, improvements in current antiretroviral therapy use over time (Adjusted Prevalence Rate Ratio [aPRR] = 1.06, 95% Confidence Interval [95% CI]: 1.01-1.11) and reductions in non-household labor (aPRR = 0.44, 95% CI: 0.20-0.99) were significantly larger among ZAMFAM beneficiaries than non-beneficiaries. For caregivers, receiving ZAMFAM services was associated with significant reductions in HIV-related stigma (aPRR = 0.49, 95% CI: 0.28-0.88) and perceived negative community attitudes towards HIV (aPRR = 0.77, 95% CI: 0.62-0.96). Improvements in caregiver capacity to pay for unexpected (aPRR = 1.54, 95% CI: 1.17-2.04) and food-related expenses (aPRR = 1.48, 95% CI: 1.16-1.90), as well as shared decision-making authority in household spending (aPRR = 1.41, 95% CI: 1.04-1.93) and self-reported good or very good health status (aPRR = 1.46, 95% CI: 1.14-1.87), were also significantly larger among ZAMFAM beneficiaries.
Significant improvements in caregivers' financial capacity were observed among households receiving ZAMFAM services, with few changes in health or wellbeing among ALHIV. Integrated service-delivery approaches like ZAMFAM may yield observable socio-economic improvements in the short-term. Strengthening community-based delivery of psychosocial and health support to ALHIV is encouraged.
在赞比亚的艾滋病毒流行中，儿童和青年是受影响最严重的群体。为了评估赞比亚家庭（ZAMFAM）项目通过整合心理社会、经济增强和临床服务向受艾滋病毒影响的家庭提供服务的情况，一项前瞻性队列研究比较了 ZAMFAM 受益人与非受益人的社会经济、心理社会和健康结果。
2017 年 7 月至 10 月，从中部（ZAMFAM 实施点）和东部（非干预点）省招募了 544 名年龄在 5-17 岁的艾滋病毒阳性青少年（ALHIV）及其成年照顾者。基线和一年随访时进行的结构化访谈评估了家庭特征、社会经济福利和卫生服务利用情况。使用广义估计方程的泊松回归测量了关键健康和社会经济指标在一年内的变化，将 ZAMFAM 受益人与非受益进行比较。
总体而言，有 494 户家庭完成了两轮评估（保留率：91%）。在 ALHIV 中，随着时间的推移，当前抗逆转录病毒治疗的使用情况有所改善（调整后的患病率比 [aPRR] = 1.06，95%置信区间 [95%CI]：1.01-1.11），非家庭劳动力的减少（aPRR = 0.44，95%CI：0.20-0.99），ZAMFAM 受益人的改善幅度明显大于非受益人群。对于照顾者，接受 ZAMFAM 服务与艾滋病毒相关耻辱感显著降低（aPRR = 0.49，95%CI：0.28-0.88）和社区对艾滋病毒的负面态度显著降低（aPRR = 0.77，95%CI：0.62-0.96）有关。照顾者应对意外（aPRR = 1.54，95%CI：1.17-2.04）和食品相关费用（aPRR = 1.48，95%CI：1.16-1.90）的能力以及在家庭支出方面的共同决策权（aPRR = 1.41，95%CI：1.04-1.93）和自我报告的良好或非常好的健康状况（aPRR = 1.46，95%CI：1.14-1.87）也有显著改善，ZAMFAM 受益人群的改善幅度明显大于非受益人群。
在接受 ZAMFAM 服务的家庭中，观察到照顾者的财务能力有了显著提高，而 ALHIV 的健康或幸福感几乎没有变化。像 ZAMFAM 这样的综合服务提供方法可能会在短期内带来可观察到的社会经济改善。鼓励加强社区为 ALHIV 提供心理社会和健康支持。
