Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
Peninsula Technology Assessment Group, University of Exeter, Exeter, United Kingdom.
J Adolesc Health. 2022 Sep;71(3):254-269. doi: 10.1016/j.jadohealth.2022.03.020. Epub 2022 May 21.
Psychosocial interventions have the potential to support adolescents and young people living with HIV (AYPLHIV) to achieve better HIV outcomes. However, more evidence is needed to understand which interventions are most effective, and the mechanisms driving how they work in practice.
We used realist methodologies to generate statements based on evidence from intervention studies and linked evidence included in a systematic review of psychosocial interventions for AYPLHIV. Key data were extracted from available sources to generate cases, including context-mechanism-outcome pathways. Higher level themes were refined iteratively to create a mid-range theory of how these interventions may work.
From 26 resulting cases, 8 statements were crafted, grouped into 3 overarching categories, to describe how these interventions worked. Interventions were overall found to set off mechanisms to improve adherence when (1) responding to individual-level factors to support AYPLHIV (via incorporating agency and empowerment, personalized and/or contextualized approaches, and self-care skills); (2) tailoring delivery strategies to address specific needs (via diverse strategies, longer duration, and digital delivery); and (3) providing supportive resources (via peer and broader support, and structural support and integration into existing services).
A collection of diverse mechanisms may individually or collectively drive improved outcomes for AYPLHIV engaged in psychosocial interventions. Recommendations for integrating our findings into practice are discussed.
心理社会干预有可能支持感染艾滋病毒的青少年和年轻人（AYPLHIV）实现更好的艾滋病毒结果。然而，需要更多的证据来了解哪些干预措施最有效，以及它们在实践中发挥作用的机制。
我们使用现实主义方法，根据干预研究的证据和系统评价中包含的针对 AYPLHIV 的心理社会干预措施的证据生成陈述。从现有来源中提取关键数据以生成案例，包括情境-机制-结果途径。通过反复细化更高层次的主题，创建了一个关于这些干预措施如何发挥作用的中观理论。
从 26 个结果案例中，制定了 8 个陈述，分为 3 个总体类别，以描述这些干预措施是如何发挥作用的。干预措施总体上被发现可以通过以下方式启动机制来提高依从性：（1）通过针对个人层面的因素来支持 AYPLHIV（通过纳入代理和赋权、个性化和/或情境化方法以及自我护理技能）；（2）根据特定需求调整交付策略（通过多样化的策略、更长的持续时间和数字交付）；和（3）提供支持资源（通过同伴和更广泛的支持，以及结构支持和整合到现有服务中）。
一系列不同的机制可能会单独或共同为接受心理社会干预的 AYPLHIV 带来更好的结果。讨论了将我们的发现纳入实践的建议。
