Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Arthur Davison Children's Hospital, Ndola, Zambia.
PLoS One. 2023 Oct 13;18(10):e0292719. doi: 10.1371/journal.pone.0292719. eCollection 2023.
The Project YES! clinic-based peer mentoring program was a randomized controlled trial (RCT) conducted among 276 youth from four HIV clinics to test the impact of the program on promoting HIV self-management and reducing internalized stigma among youth living with HIV (ages 15-24 years) in Ndola, Zambia. We conducted a qualitative sub-study involving in-depth interviews with 40 intervention youth participants (21 female, 19 male) to explore their experiences with Project YES! which included: an orientation meeting led by a healthcare provider, monthly individual and group counseling sessions over six months, and three optional caregiver group sessions. Using baseline RCT data, we used maximum variation sampling to purposively select youth by sex, age, change in virologic results between baseline and midline, and study clinic. A four-person team conducted thematic coding. Youth described their increased motivation to take their HIV care seriously due to Project YES!, citing examples of improvements in ART adherence and for some, virologic results. Many cited changes in behavior in the context of greater feelings of self-worth and acceptance of their HIV status, resulting in less shame and fear associated with living with HIV. Youth also attributed Project YES! with reducing their sense of isolation and described Project YES! youth peer mentors and peers as their community and "family." Findings highlight that self-worth and personal connections play a critical role in improving youths' HIV outcomes. Peer-led programs can help foster these gains through a combination of individual and group counseling sessions. Greater attention to the context in which youth manage their HIV, beyond medication intake, is needed to reach global HIV targets.
“YES！”项目是以诊所为基础的同伴指导计划，在赞比亚恩多拉的四个艾滋病毒诊所中，对 276 名青年进行了一项随机对照试验（RCT），以检验该计划对促进艾滋病毒自我管理和减少艾滋病毒感染者内化污名的影响。研究人员进行了一项定性子研究，对 40 名干预组青年参与者（21 名女性，19 名男性）进行了深入访谈，探讨他们对“YES！”项目的体验，该项目包括：由医疗保健提供者领导的一次介绍会、六个月内每月进行一次个人和小组咨询、以及三次可选的照顾者小组会议。研究人员使用基线 RCT 数据，采用最大变异抽样，根据性别、年龄、基线和中值之间病毒学结果的变化以及研究诊所，有针对性地选择青年。一个四人小组进行了主题编码。青年们描述了由于“YES！”项目，他们更加认真地对待自己的艾滋病毒护理，他们举例说明了在抗逆转录病毒治疗（ART）依从性方面的改善，对于一些人来说，还有病毒学结果的改善。许多人表示，由于自我价值感的提高和对艾滋病毒状况的接受程度的增加，他们的行为发生了变化，因此与艾滋病毒相关的耻辱感和恐惧感减少了。青年们还将“YES！”项目归因于减少了他们的孤立感，并将“YES！”项目青年同伴导师和同伴描述为他们的社区和“家人”。研究结果表明，自我价值感和个人联系在改善青年的艾滋病毒结果方面发挥着至关重要的作用。同伴领导的项目可以通过个人和小组咨询会议的结合来帮助培养这些收益。需要更加关注青年管理艾滋病毒的背景，而不仅仅是药物摄入，以实现全球艾滋病毒目标。
