Partners In Health, Neno, Malawi
Partners In Health, Neno, Malawi.
BMJ Open. 2023 Aug 16;13(8):e069870. doi: 10.1136/bmjopen-2022-069870.
To compare the impact of a teen club model to the standard care model on HIV treatment outcomes among adolescents (10-19 years of age).
Retrospective cohort study.
HIV clinics in Neno district, Malawi.
Adolescents living with HIV enrolled in teen clubs (n=235) and matched participants in standard HIV care (n=297).
Attrition from HIV care, defined as a combination of treatment outcomes 'died', 'defaulted' and 'transferred out'.
Over a 4-year follow-up period, adolescents who participated in the teen club had a significantly higher likelihood of remaining in care than those who did not (HR=2.80; 95% CI: 1.46 to 5.34). Teen clubs also increased the probability of having a recent measured viral load (VL) and BMI, but did not change the probability of VL suppression. The age at antiretroviral treatment initiation below 15 years (aHR=0.37; 95% CI: 0.17 to 0.82) reduced the risk of attrition from HIV care, while underweight status (aHR=3.18; 95% CI: 1.71 to 5.92) increased the risk of attrition, after controlling for sex, WHO HIV staging and teen club participation.
The teen club model has the potential to improve treatment outcomes among adolescents in rural Neno district. However, in addition to retaining adolescents in HIV care, greater attention is needed to treatment adherence and viral suppression in this special population. Further understanding of the contextual factors and barriers that adolescents in rural areas face could further improve the teen club model to ensure high-quality HIV care and quality of life.
比较青少年俱乐部模式与标准护理模式对青少年（10-19 岁）艾滋病毒治疗结果的影响。
回顾性队列研究。
马拉维内诺区的艾滋病毒诊所。
参加青少年俱乐部的艾滋病毒感染者青少年（n=235）和标准艾滋病毒护理的匹配参与者（n=297）。
艾滋病毒护理的流失，定义为“死亡”、“失访”和“转出”治疗结局的组合。
在 4 年的随访期间，参加青少年俱乐部的青少年留在护理中的可能性明显高于未参加者（HR=2.80；95%CI：1.46 至 5.34）。青少年俱乐部还增加了最近测量的病毒载量（VL）和体重指数（BMI）的可能性，但没有改变 VL 抑制的可能性。15 岁以下开始抗逆转录病毒治疗的年龄（aHR=0.37；95%CI：0.17 至 0.82）降低了艾滋病毒护理流失的风险，而体重不足状态（aHR=3.18；95%CI：1.71 至 5.92）增加了艾滋病毒护理流失的风险，控制了性别、世界卫生组织艾滋病毒分期和青少年俱乐部参与情况。
青少年俱乐部模式有可能改善农村内诺区青少年的治疗结果。然而，除了让青少年继续接受艾滋病毒护理外，还需要更加关注这一特殊人群的治疗依从性和病毒抑制。进一步了解农村地区青少年面临的背景因素和障碍，可以进一步改进青少年俱乐部模式，以确保高质量的艾滋病毒护理和生活质量。
