Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Glob Health Res Policy. 2021 Oct 15;6(1):40. doi: 10.1186/s41256-021-00224-0.
Safety protocols are an essential component of studies addressing violence and mental health but are rarely described in the published literature from Sub-Saharan Africa. We designed and implemented a safety protocol within Project YES! (Youth Engaging for Success), which enrolled 276 youth living with HIV (ages 15-24 years) in a randomized controlled trial of a peer-mentoring intervention across four HIV clinics in Ndola, Zambia.
Youth who reported severe violence and/or suicidal thoughts on research surveys or during meetings with youth peer mentors (YPM) were referred to designated healthcare providers (HCP). We explored experiences with the safety protocol using: a) monitoring data of referrals, and b) in-depth interviews with youth (n = 82), HCP (n = 10), YPM (n = 8), and staff (n = 6). Descriptive statistics were generated and thematic analysis of coded transcripts and written memos performed.
Nearly half of youth enrolled (48% of females, 41% of males) were referred to a HCP at least once. The first referral was most often for sexual violence (35%) and/or suicidal ideation/depression (29%). All referred youth aged 15-17 years and over 80% of referred youth aged 18 + agreed to see a HCP. HCP referred 15% for additional services outside the clinic. Twenty-nine youth, all HCP, all YPM, and all staff interviewed discussed the safety protocol. Most youth felt "encouraged," "helped," "unburdened," and "relieved" by their meetings with HCP; some expressed concerns about meeting with HCP. The safety protocol helped HCP recognize the need to integrate care for violence and mental health with medication adherence support. HCP, YPM, and study staff raised implementation challenges, including youth choosing not to open up to HCP, time and resource constraints, deficiencies in HCP training, and stigma and cultural norms inhibiting referrals outside the clinic for emotional trauma and mental health.
Implementing a safety protocol within an HIV clinic-based research study is possible and beneficial for youth and HCP alike. Implementation challenges underscore that HCP in Zambia work in over-stretched healthcare systems. Innovative strategies must address deficiencies in training and resources within HIV clinics and gaps in coordination across services to meet the overwhelming need for violence and mental health services among youth living with HIV.
安全协议是研究暴力和心理健康问题不可或缺的组成部分，但在撒哈拉以南非洲的已发表文献中很少有描述。我们在赞比亚恩多拉的四个艾滋病毒诊所进行的一项同伴辅导干预的随机对照试验中，为 YES！（青年参与成功）项目设计并实施了一项安全协议，该项目纳入了 276 名感染艾滋病毒的青年（年龄在 15-24 岁之间）。
在研究调查或与青年同伴导师（YPM）的会议上报告严重暴力和/或自杀念头的青年被转介给指定的医疗保健提供者（HCP）。我们使用以下方法探讨了安全协议的经验：a）监测转介数据，b）对青年（n=82）、HCP（n=10）、YPM（n=8）和工作人员（n=6）进行深入访谈。生成描述性统计数据，并对编码转录本和书面备忘录进行主题分析。
近一半的入组青年（48%的女性，41%的男性）至少被转介给一名 HCP。第一次转介最常是因为性暴力（35%）和/或自杀意念/抑郁（29%）。所有转介的 15 岁以下青年和 80%以上的 18 岁以上转介青年都同意去看 HCP。HCP 还将 15%的人转介到诊所外的其他服务机构。29 名青年、所有 HCP、所有 YPM 和所有接受采访的工作人员都讨论了安全协议。大多数青年感到“受到鼓励”、“得到帮助”、“减轻负担”和“如释重负”，他们与 HCP 的会面；一些人对与 HCP 会面表示担忧。安全协议帮助 HCP 认识到需要将暴力和心理健康护理与药物依从性支持相结合。HCP、YPM 和研究工作人员提出了实施方面的挑战，包括青年选择不向 HCP 敞开心扉、时间和资源限制、HCP 培训不足以及诊所外转诊的耻辱感和文化规范抑制了对情感创伤和心理健康的服务。
在艾滋病毒诊所为基础的研究中实施安全协议对青年和 HCP 都是可行且有益的。实施方面的挑战凸显出赞比亚的 HCP 在资源紧张的医疗保健系统中工作。创新策略必须解决艾滋病毒诊所培训和资源方面的不足，以及服务之间协调方面的差距，以满足艾滋病毒感染者中青少年对暴力和心理健康服务的巨大需求。
