Antelman Gretchen, Jahanpour Ola, Machalo Thomas, Audi Cosette, van de Ven Roland, Rutaihwa Mastidia, Lankiewicz Elise, Baird Sarah
Elizabeth Glaser Pediatric AID Foundation, Dar es Salaam, Tanzania.
Elizabeth Glaser Pediatric AID Foundation, Washington, DC, United States of America.
PLOS Glob Public Health. 2022 Oct 3;2(10):e0000065. doi: 10.1371/journal.pgph.0000065. eCollection 2022.
HIV treatment outcomes may be improved by ameliorating psychosocial challenges adolescents living with HIV (ALHIV) face. This analysis describes participation in existing facility-based adolescent clubs and the associations between club attendance, adolescent well-being and HIV treatment outcomes. Data were collected through interviews with a sub-sample of adolescents age 10-19 years and medical record abstraction of all adolescents attending HIV services at seven clinics in Tanzania. Independent variables included adolescent club attendance, self-esteem, self-efficacy, mental distress, social capital and other health utilization or HIV experience characteristics. Study outcomes included visit adherence, viral suppression (<1000 cp/ml), and retention. Of 645 adolescents attending HIV services, 75% attended clubs at least once with a median of eight club sessions attended over a two-year period. Mental distress was prevalent, with 67% of the adolescents scoring above a recognized cut-off of ≥5. Adolescents who attended 10 or more clubs, compared to those not attending any clubs over a two-year period were at an almost three-fold increased odds of having good visit adherence (odds ratio [OR] 2.72, 95% confidence interval [CI]: 1.25, 5.94). Club attendance was also associated with sustained retention in the following year: adolescents who attended some clubs (1-9) had three-times the odds of being retained (OR 3.01; 95%CI: 1.86, 4.87) while those who attended 10+ had over seven-times the odds (OR 7.29; 95%CI: 4.34, 12.22). Among the 154 adolescents who were interviewed, being in the top self-efficacy tertile was positively associated with viral suppression (OR 3.04, 95%CI: 1.08, 8.60) and retention (OR 4.44, 95%CI: 1.19, 17.40). Attending the HIV clinic with a guardian/treatment supporter (OR 3.29, 95%CI: 1.17, 9.22) was also associated with viral suppression. Self-efficacy, social capital and treatment support are associated with better health outcomes among adolescents. However, many ALHIV either never attended or did not regularly attend clubs.
改善感染艾滋病毒的青少年（ALHIV）所面临的心理社会挑战，可能会改善艾滋病毒治疗结果。本分析描述了参与现有的基于机构的青少年俱乐部的情况，以及俱乐部参与度、青少年幸福感和艾滋病毒治疗结果之间的关联。通过对10至19岁青少年的子样本进行访谈，并对坦桑尼亚七家诊所接受艾滋病毒服务的所有青少年的病历进行摘要提取来收集数据。自变量包括青少年俱乐部参与度、自尊、自我效能感、心理困扰、社会资本以及其他医疗利用或艾滋病毒经历特征。研究结果包括就诊依从性、病毒抑制（<1000拷贝/毫升）和留存率。在645名接受艾滋病毒服务的青少年中，75%至少参加过一次俱乐部，在两年期间参加俱乐部会议的中位数为8次。心理困扰很普遍，67%的青少年得分高于公认的≥5的临界值。在两年期间参加10次或更多俱乐部的青少年，与未参加任何俱乐部的青少年相比，有良好就诊依从性的几率几乎增加了两倍（优势比[OR]2.72，95%置信区间[CI]：1.25，5.94）。俱乐部参与度还与次年的持续留存率相关：参加过一些俱乐部（1 - 9次）的青少年被留存的几率是三倍（OR 3.01；95%CI：1.86，4.87），而参加10次及以上的青少年被留存的几率超过七倍（OR 7.29；95%CI：4.34，12.22）。在接受访谈的154名青少年中，自我效能感处于最高三分位数与病毒抑制（OR 3.04，95%CI：1.08，8.60）和留存率（OR 4.44，95%CI：1.19，17.40）呈正相关。与监护人/治疗支持者一起前往艾滋病毒诊所（OR 3.29，95%CI：1.17，9.22）也与病毒抑制相关。自我效能感、社会资本和治疗支持与青少年更好的健康结果相关。然而，许多感染艾滋病毒的青少年要么从未参加过俱乐部，要么没有定期参加俱乐部。
