支持团体对感染艾滋病毒的弱势儿童和青年的健康和福祉的重要性：以海地儿童俱乐部项目为例的个案研究。

Importance of support groups to the health and well-being of vulnerable children and young people living with HIV: a case study of the Kids Clubs program in Haiti.

机构信息

Palladium, 1331 Pennsylvania Avenue NW, Suite 600, Washington, DC, 20004, USA.

Société d'Études et de Formation en Information Stratégique, Port-au-Prince, Haiti.

出版信息

BMC Health Serv Res. 2021 Mar 16;21(1):236. doi: 10.1186/s12913-021-06242-5.

DOI:10.1186/s12913-021-06242-5

PMID:33726734

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7967958/

Abstract

BACKGROUND

Although access to antiretroviral therapy (ART) among children and young people living with HIV has increased in recent years, adherence to medication and viral suppression remain challenges. Evidence of benefits of support groups is growing and reflects a range of models and approaches. Since 2014, hospital-linked psychosocial support groups for children and young people living with HIV, known as Kids Clubs, have been established throughout Haiti. The program provides safe spaces for them to meet with peers, supports medication adherence, delivers health and life skills education, and facilitates linkages with clinic visits and social services. This study describes program enrollment and participant engagement, ART adherence and viral suppression among participants, and other outcomes attributed to the program by participants, caregivers, and program implementers.

METHODS

Our mixed methods study included quantitative analysis of program monitoring data on rollout and attendance, and medication adherence and viral load results extracted from medical records. We collected qualitative data from club members, caregivers, and implementers about their experiences with the clubs and the impact of participation.

RESULTS

From January 2014-December 2018, 1330 individuals aged 8-29 were enrolled in the program; over three-quarters participated for at least 12 months. In 2018, 1038 members attended at least one club meeting; more than half missed three or fewer monthly meetings. Three-quarters of ever-enrolled members reported consistent medication use at their most recent clinic visit; 64.2% (600/935) of those with a recent viral load test were virally suppressed. Level of club attendance was positively associated with ART adherence (p < 0.01) and viral suppression (p < 0.05). Club members, caregivers, and implementers noted the value of the clubs to participants' retention in care and medication adherence, health knowledge, and capacity to deal with peer pressure, stigma, shyness, and depression.

CONCLUSIONS

The Kids Club program has been successful in scaling HIV support services to highly vulnerable children and young people through peer-based groups, and program participation has led to a range of benefits. Efforts to innovate, evaluate, and scale support strategies for vulnerable young populations must be accelerated in order to ensure that they survive, thrive, and reach their full potential.

摘要

背景

尽管近年来感染艾滋病毒的儿童和青少年获得抗逆转录病毒治疗（ART）的机会有所增加，但他们对药物的坚持和病毒抑制仍然存在挑战。支持团体的益处的证据越来越多，反映了一系列的模式和方法。自 2014 年以来，海地各地都建立了与医院有关联的艾滋病毒感染儿童和青少年心理社会支持团体，称为儿童俱乐部。该方案为他们提供了与同龄人会面的安全空间，支持药物坚持，提供健康和生活技能教育，并促进与诊所就诊和社会服务的联系。本研究描述了该方案的参与情况、参与者的 ART 坚持和病毒抑制情况，以及参与者、照顾者和方案实施者认为该方案带来的其他结果。

方法

我们的混合方法研究包括对方案推出和出席情况的方案监测数据进行定量分析，以及从病历中提取的药物坚持和病毒载量结果。我们从俱乐部成员、照顾者和实施者那里收集了关于他们参与俱乐部的经验以及参与的影响的定性数据。

结果

从 2014 年 1 月至 2018 年 12 月，共有 1330 名 8-29 岁的人参加了该方案；超过四分之三的人至少参加了 12 个月。2018 年，有 1038 名成员参加了至少一次俱乐部会议；超过一半的人每月只错过了三到四次会议。四分之三的曾经参加过的成员报告说，在最近的诊所就诊时，他们一直在坚持服药；在最近进行了病毒载量检测的 600 人中，有 64.2%（600/935）病毒得到抑制。俱乐部出席率与 ART 坚持呈正相关（p<0.01）和病毒抑制（p<0.05）。俱乐部成员、照顾者和实施者注意到俱乐部对参与者保持护理和药物坚持、健康知识以及应对同伴压力、污名、害羞和抑郁的能力的重要性。