Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Department of Psychiatry and Mental Health and Centre for Social Science Research.
AIDS. 2023 Mar 1;37(3):503-511. doi: 10.1097/QAD.0000000000003440. Epub 2022 Dec 5.
We are failing to reach 95-95-95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally.
A prospective cohort of ALHIV (sample N = 980, 55% female individuals, baseline mean age 13.6 years) were recruited from 53 health facilities in South Africa's Eastern Cape Province and responded to a structured questionnaire at 18-month and 36-month follow-up (2015-2016, 2017-2018).
A repeated-measures random effects model assessed multivariable associations of self-reported sexual abuse and IPV with past-week ART adherence, controlling for individual, socioeconomic, and HIV-related factors. Past-week adherence was defined based on currently taking ART and not having missed any doses in the past 7 days (including weekends). We further fitted a moderation model by sex.
Fifty-one percent of adolescents reported consistent ART adherence at both time points. Exposure to IPV was associated with lower odds of self-reported ART adherence (aOR 0.39, 95% CI 0.21-0.72, P = 0.003), as was sexual abuse (aOR 0.54, 95% CI 0.29-0.99, P = 0.048). The marginal predicted probability of ART adherence for adolescents with no exposure to either IPV or sexual abuse was 72% (95% CI 70-74%) compared with 38% (95% CI 20-56%) for adolescents with exposure to both IPV and sexual abuse. Moderation results showed similar associations between sexual violence and ART adherence by sex.
Sexual violence prevention and postviolence care may be essential components of supporting adolescent ART adherence. Integration of HIV and violence prevention services will require accessible services and simple referral systems.
我们未能实现艾滋病毒感染者青少年（ALHIV）的 95-95-95 目标。性虐待和亲密伴侣暴力（IPV）可能会影响抗逆转录病毒治疗（ART）的依从性，在撒哈拉以南非洲南部地区，这两种情况的发生率分别高达 17.4%和 29.7%。然而，关于它们与青少年接受 ART 治疗的依从性之间的关联的证据仍然有限，全球仅有三项横断面研究。
一项针对来自南非东开普省 53 个卫生设施的 ALHIV 的前瞻性队列研究（样本量 N=980，55%为女性，基线平均年龄为 13.6 岁），并在 18 个月和 36 个月时进行了随访（2015-2016 年，2017-2018 年），采用结构化问卷进行了调查。
采用重复测量随机效应模型评估了自我报告的性虐待和 IPV 与过去一周 ART 依从性的多变量关联，控制了个体、社会经济和 HIV 相关因素。过去一周的依从性是根据目前正在服用 ART 且在过去 7 天内没有错过任何剂量（包括周末）来定义的。我们进一步通过性别拟合了一个调节模型。
51%的青少年在两个时间点都报告了持续的 ART 依从性。遭受 IPV 与报告的 ART 依从性降低有关（调整后的比值比 0.39，95%可信区间 0.21-0.72，P=0.003），性虐待也与报告的 ART 依从性降低有关（调整后的比值比 0.54，95%可信区间 0.29-0.99，P=0.048）。没有同时暴露于 IPV 和性虐待的青少年的 ART 依从性的边际预测概率为 72%（95%可信区间 70-74%），而同时暴露于 IPV 和性虐待的青少年的 ART 依从性的边际预测概率为 38%（95%可信区间 20-56%）。调节结果表明，性暴力与 ART 依从性之间的关联在性别上相似。
性暴力预防和暴力后护理可能是支持青少年接受 ART 治疗的重要组成部分。需要建立方便获取和简单的转介系统，以整合艾滋病毒和暴力预防服务。
