Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
AIDS. 2021 Jul 1;35(8):1263-1271. doi: 10.1097/QAD.0000000000002882.
Adolescent antiretroviral treatment (ART) adherence remains critically low. We lack research testing protective factors across both clinic and care environments.
A prospective cohort of adolescents living with HIV (sample n = 969, 55% girls, baseline mean age 13.6) in the Eastern Cape Province in South Africa were interviewed at baseline and 18-month follow-up (2014-2015, 2015-2016). We traced all adolescents ever initiated on treatment in 52 government health facilities (90% uptake, 93% 18-month retention, 1.2% mortality).
Clinical records were collected; standardized questionnaires were administered by trained data collectors in adolescents' language of choice. Probit within-between regressions and average adjusted probability calculations were used to examine associations of caregiving and clinic factors with adherence, controlling for household structure, socioeconomic and HIV factors.
Past-week ART adherence was 66% (baseline), 65% (follow-up), validated against viral load in subsample. Within-individual changes in three factors were associated with improved adherence: no physical and emotional violence (12.1 percentage points increase in adjusted probability of adherence, P < 0.001), improvement in perceived healthcare confidentiality (7.1 percentage points, P < 0.04) and shorter travel time to the clinic (13.7 percentage points, P < 0.02). In combination, improvement in violence prevention, travel time and confidentiality were associated with 81% probability of ART adherence, compared with 47% with a worsening in all three.
Adolescents living with HIV need to be safe at home and feel safe from stigma in an accessible clinic. This will require active collaboration between health and child protection systems, and utilization of effective violence prevention interventions.
青少年抗逆转录病毒治疗（ART）的依从性仍然极低。我们缺乏在诊所和护理环境中测试保护因素的研究。
在南非东开普省，对一组接受艾滋病毒治疗的青少年（样本 n=969，55%为女孩，基线平均年龄为 13.6 岁）进行了前瞻性队列研究。在基线和 18 个月随访时（2014-2015 年，2015-2016 年）对他们进行了访谈。我们追踪了在 52 家政府卫生机构中接受治疗的所有青少年（90%的接受率，93%的 18 个月保留率，1.2%的死亡率）。
收集临床记录；由经过培训的数据收集员使用青少年选择的语言对他们进行标准化问卷访谈。使用 Probit 内外回归和平均调整概率计算，控制家庭结构、社会经济和 HIV 因素，检验照顾者和诊所因素与依从性的关联。
过去一周的 ART 依从率为 66%（基线），65%（随访），在亚组中用病毒载量进行了验证。与依从性提高相关的三个因素的个体内变化包括：没有身体和情感暴力（调整后依从概率增加 12.1 个百分点，P<0.001）、感知医疗保健保密性提高（7.1 个百分点，P<0.04）和前往诊所的旅行时间缩短（13.7 个百分点，P<0.02）。综合来看，预防暴力、缩短旅行时间和提高保密性的改善与 81%的 ART 依从率相关，而三者同时恶化的概率为 47%。
感染艾滋病毒的青少年在家中需要安全，在可及的诊所中免受污名化的影响。这将需要卫生和儿童保护系统之间的积极合作，并利用有效的暴力预防干预措施。
