Pediatric Infectious Diseases, Emory University, Atlanta, Georgia, USA
Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
BMJ Open. 2022 Apr 29;12(4):e057797. doi: 10.1136/bmjopen-2021-057797.
Compared with adults, adolescents in South Africa have larger gaps at each step of the HIV continuum of care resulting in low levels of viral suppression.
We conducted a systematic review and modified Delphi analysis of interventions addressing the HIV continuum of care for adolescents in South Africa. We searched PubMed, Science Direct, and Google Scholar and online conference proceedings from the International AIDS Society, the International AIDS Conference, and the Conference on Retrovirology and Opportunistic Infections from 1 January 2010 to 30 September 2020. We then conducted a modified Delphi analysis with 29 researchers involved in the National Institutes of Health's Fogarty International-supported Adolescent HIV Implementation Science Alliance-South Africa to evaluate interventions for efficacy, feasibility and potential for scale-up.
We identified nine initial published articles containing interventions addressing the adolescent HIV continuum of care in South Africa, including five interventions focused on HIV diagnosis, two on antiretroviral therapy adherence and two on retention in care. No studies addressed linkage to care or transition from paediatric to adult care. Two studies discussed intervention costs. In-home and HIV self-testing, community-based adherence support, and provision of adolescent-friendly services were the most impactful and scalable interventions addressing the adolescent HIV continuum of care.
Future interventions should work comprehensively across the adolescent HIV continuum of care and be tailored to the specific needs of adolescents.
与成年人相比，南非青少年在艾滋病护理连续体的每一步都存在更大的差距，导致病毒抑制率较低。
我们对针对南非青少年艾滋病护理连续体的干预措施进行了系统评价和改良 Delphi 分析。我们在 PubMed、Science Direct 和 Google Scholar 以及国际艾滋病协会、国际艾滋病会议和逆转录病毒和机会性感染会议的在线会议记录中进行了检索，时间范围为 2010 年 1 月 1 日至 2020 年 9 月 30 日。然后，我们与参与美国国立卫生研究院 Fogarty 国际支持的青少年艾滋病实施科学联盟-南非的 29 名研究人员进行了改良 Delphi 分析，以评估干预措施的疗效、可行性和扩大规模的潜力。
我们确定了九篇最初发表的包含针对南非青少年艾滋病护理连续体的干预措施的文章，其中五项干预措施侧重于艾滋病诊断，两项干预措施侧重于抗逆转录病毒治疗的依从性，两项干预措施侧重于护理的保留。没有研究涉及到联系护理或从儿科护理过渡到成人护理。两项研究讨论了干预措施的成本。家庭内和艾滋病自我检测、基于社区的依从性支持以及提供适合青少年的服务是最具影响力和可扩展性的针对青少年艾滋病护理连续体的干预措施。
未来的干预措施应全面涵盖青少年艾滋病护理连续体，并针对青少年的具体需求进行调整。
