ICAP at Columbia University, Mailman School of Public Health, New York, USA.
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
BMC Public Health. 2021 Sep 10;21(1):1650. doi: 10.1186/s12889-021-11707-7.
In Mozambique, HIV infection remains a leading cause of adolescent mortality. With advances in antiretroviral treatment (ART), the population of adolescents living with vertically-acquired HIV is growing. Most studies of adolescents living with HIV (ALHIV) focus on older youth with horizontal infection. As part of a larger study, we examined the characteristics and health care needs of younger ALHIV, including those with vertically-acquired infection to inform preventive interventions.
We used a convergent mixed-methods design and recruited ALHIV aged 12-14 years who were enrolled in HIV care in three health clinics in Nampula, Mozambique. From 11/2019-3/2020, we conducted 61 quantitative surveys and 14 in-depth interviews with a purposively selected subset of ALHIV who were aware of their HIV status. Descriptive statistical analysis was conducted for quantitative data. Qualitative data were transcribed and analyzed using thematic analysis.
The median age of ALHIV was 13 years, 50% were female, 67% lived with ≥1 parent, 70% had lost a parent, 100% were in school; 10% were in a relationship, and 3% had initiated sexual activity. Among 31 ALHIV aware of their serostatus, the median age of antiretroviral treatment (ART) initiation was 8 years (IQR: 6-11); 55% received caregiver support for ART management; 35% reported missing ≥1 ART dose in the last 30 days; 6% had disclosed their HIV-status to friends and 48% reported no one to talk to about HIV-specific issues. Four main themes emerged from the qualitative interviews with ALHIV: a) learning one's HIV-positive status as the beginning of a secret life; b) importance of caregivers' support for ART management; c) high value of ALHIV peer support to overcome isolation, increase HIV literacy, and support adherence; and d) unmet needs for sexual and reproductive health education.
HIV-related secrecy prevails among ALHIV, a situation exacerbated by caregivers and healthcare providers. Caregivers play a major role in supporting adherence among young ALHIV, yet ALHIV could also benefit from adolescent-friendly services, including peer support, sexual and reproductive health services and preparation for independent health management. Integrating such programs into ART services in Mozambique may be critical to promoting ALHIV health.
在莫桑比克，艾滋病毒感染仍然是青少年死亡的主要原因。随着抗逆转录病毒治疗（ART）的进步，垂直获得艾滋病毒感染的青少年人数不断增加。大多数关于感染艾滋病毒的青少年（ALHIV）的研究都集中在感染水平传播的年龄较大的青少年上。作为一项更大研究的一部分，我们检查了包括垂直获得感染的年轻 ALHIV 的特征和医疗保健需求，以为预防干预措施提供信息。
我们使用了收敛混合方法设计，并招募了在莫桑比克楠普拉的三个卫生诊所接受艾滋病毒护理的年龄在 12-14 岁的 ALHIV。从 2019 年 11 月至 2020 年 3 月，我们对一组经过精心挑选的、知道自己艾滋病毒状况的 ALHIV 进行了 61 项定量调查和 14 次深入访谈。对定量数据进行描述性统计分析。对定性数据进行转录和主题分析。
ALHIV 的中位年龄为 13 岁，50%为女性，67%与≥1 位父母同住，70%失去了父母，100%在上学；10%处于恋爱关系，3%有过性行为。在 31 名知晓自己血清状况的 ALHIV 中，抗逆转录病毒治疗（ART）开始的中位年龄为 8 岁（IQR：6-11）；55%接受了照顾者对 ART 管理的支持；35%报告在过去 30 天内漏服≥1 剂 ART；6%向朋友透露了自己的 HIV 状况，48%表示没有人可以谈论 HIV 相关问题。从与 ALHIV 的定性访谈中得出了四个主题：a）得知自己 HIV 阳性是秘密生活的开始；b）照顾者对 ART 管理的支持非常重要；c）ALHIV 同伴支持对于克服孤立、提高 HIV 知识和支持坚持治疗非常重要；d）性和生殖健康教育方面存在未满足的需求。
ALHIV 普遍存在与艾滋病毒相关的秘密，这种情况因照顾者和医疗保健提供者而加剧。照顾者在支持年轻 ALHIV 坚持治疗方面发挥了重要作用，但 ALHIV 也可以从青少年友好型服务中受益，包括同伴支持、性和生殖健康服务以及为独立健康管理做准备。将这些项目纳入莫桑比克的 ART 服务中可能对促进 ALHIV 的健康至关重要。
