Phiri Mwelwa M, Hensen Bernadette, Sigande Lucheka M, Floyd Sian, Schaap Albertus J, Simuyaba Melvin, Mwenge Lawrence, Zulu-Phiri Rosemary, Mwape Louis, Fidler Sarah, Simwinga Musonda, Hayes Richard, Ayles Helen M
Zambart, Lusaka, Zambia.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
PLOS Glob Public Health. 2023 Nov 14;3(11):e0002446. doi: 10.1371/journal.pgph.0002446. eCollection 2023.
INTRODUCTION: Adolescents and young people (AYP) aged 15-24 years have the least access to facility-based sexual and reproductive health (SRH) services, including HIV services. The Yathu-Yathu cluster-randomized trial (CRT) in Zambia tested whether a novel peer-led community-based approach increased knowledge of HIV status amongst AYP. In this nested case-control study, we aimed to identify factors associated with non-attendance to the Yathu Yathu hubs by adolescent boys and young men (ABYM) aged 18-24-years. METHODS: Yathu Yathu was a CRT conducted in two communities in Lusaka, Zambia, with 10 intervention and 10 control zones. AYP in all zones were offered prevention points cards (PPC), which incentivized and tracked service use at the hubs and health facility. In intervention zones, services were provided to AYP through community-based spaces (hubs) led by peer support workers. In these zones, cases were defined as those not having accessed any service at a hub and controls as those that accessed at least one service. Data were collected from October 2020 to January 2021 and analysed using methods appropriate for unmatched case-control studies. RESULTS: 161 cases and 160 controls consented to participate in the study. Participants aged 20-24 years (adjOR 1.99, 95%CI 1.26-3.12, p = 0.003), who were educated up to college level (adjOR 8.47,95%CI 2.08-34.53, p = 0.001) or who reported being employed in the last 12 months (adjOR 2.15, 95%CI 1.31-3.53, p = 0.002) were more likely to not attend the hubs. ABYM who had a friend with a PPC were more likely to attend the hubs (adjOR 0.18 95%CI 0.09-0.35, p<0.001). Most cases reported having their last HIV test at the local government health facility (58%) while most controls reported HIV-testing at a Yathu Yathu hub (82%). Among the controls, 84% (134/160) rated the hub experience as excellent. Among cases, 65% (104/161) stated they didn't visit the hubs "due to employment". CONCLUSIONS: Despite Yathu Yathu services being community-based and more accessible compared to health facilities, we found age, education and employment were associated with not attending hubs. Strategies are needed to reach employed young men who may not have access to SRH/HIV services during conventional working hours and to better utilise peer networks to increase service use.
引言：15至24岁的青少年和年轻人获得基于机构的性与生殖健康（SRH）服务（包括艾滋病毒服务）的机会最少。赞比亚的Yathu-Yathu整群随机试验（CRT）测试了一种新型的同伴主导的社区方法是否能提高青少年和年轻人对艾滋病毒感染状况的知晓率。在这项嵌套病例对照研究中，我们旨在确定18至24岁的青少年男孩和年轻男性（ABYM）未前往Yathu Yathu中心的相关因素。 方法：Yathu Yathu是在赞比亚卢萨卡的两个社区进行的一项整群随机试验，有10个干预区和10个对照区。所有区域的青少年和年轻人都获得了预防积分卡（PPC），该积分卡激励并跟踪在中心和医疗机构的服务使用情况。在干预区，通过同伴支持工作者领导的社区空间（中心）向青少年和年轻人提供服务。在这些区域，病例被定义为未在中心获得任何服务的人，对照为至少获得一项服务的人。数据收集于2020年10月至2021年1月，并使用适用于非匹配病例对照研究的方法进行分析。 结果：161例病例和160例对照同意参与研究。年龄在20至24岁之间的参与者（调整后比值比1.99，95%置信区间1.26 - 3.12，p = 0.003）、受过大学教育的参与者（调整后比值比8.47，95%置信区间2.08 - 34.53，p = 0.001）或报告在过去12个月内有工作的参与者（调整后比值比2.15，95%置信区间1.31 - 3.53，p = 0.002）更有可能不前往中心。有持有预防积分卡朋友的ABYM更有可能前往中心（调整后比值比0.18，95%置信区间0.09 - 0.35，p<0.001）。大多数病例报告最后一次艾滋病毒检测是在当地政府医疗机构（58%），而大多数对照报告在Yathu Yathu中心进行艾滋病毒检测（82%）。在对照中，84%（134/160）将在中心的体验评为优秀。在病例中，65%（104/161）表示他们“因工作”未前往中心。 结论：尽管Yathu Yathu服务是基于社区的，且与医疗机构相比更容易获得，但我们发现年龄、教育和就业与不前往中心有关。需要制定策略，以覆盖那些在常规工作时间可能无法获得性与生殖健康/艾滋病毒服务的就业青年男子，并更好地利用同伴网络来增加服务使用。
J Acquir Immune Defic Syndr. 2023-8-1
BMC Public Health. 2019-12-30
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