Munyayi Farai Kevin, van Wyk Brian
School of Public Health, University of the Western Cape, Cape Town, South Africa.
HIV AIDS (Auckl). 2024 Jul 10;16:259-273. doi: 10.2147/HIV.S459124. eCollection 2024.
Adolescents living with HIV (ALHIV) face unique challenges that result in persistent gaps in achieving and maintaining suppressed viral load. Although effective evidence-based interventions to address treatment gaps in adolescents are readily available, health systems in resource-constrained, high HIV prevalence settings are challenged to implement them to achieve epidemic control. Here, we describe the health system responses to address the treatment gap of unsuppressed ALHIV on antiretroviral therapy in Windhoek, Namibia.
We conducted a qualitative descriptive and exploratory study in Windhoek between June and October 2023. Nineteen purposively selected key informants, ranging from pediatric HIV program managers to healthcare providers, were interviewed. In-depth interviews were audio-recorded and transcribed verbatim. The transcripts were uploaded to ATLAS.ti and subjected to thematic analysis.
The four main themes elucidated challenges related to adherence and retention as well as health system responses in the form of interventions and support programs. The predominant adherence and retention challenges faced by ALHIV were mental health issues, behavioral and medication-related challenges, and inadequate care and social support. The health system responses to the identified challenges included providing psychosocial support, peer support, optimization of treatment and care, and the utilization of effective service delivery models. Key health system support elements identified included adequately capacitated human resources, efficient medication supply chain systems, creating and maintaining an enabling environment for optimum care, and robust monitoring systems as essential to program success.
The health system responses to address the remaining treatment gaps of unsuppressed ALHIV in Windhoek are quite varied and, although evidence-based, appear to be siloed. We recommend harmonized, multifaceted guidance, integrating psychosocial, treatment, care, and peer-led support, and strengthening client-centred differentiated service delivery models for unsuppressed adolescents.
感染艾滋病毒的青少年（ALHIV）面临着独特的挑战，这导致在实现和维持病毒载量抑制方面持续存在差距。尽管有基于证据的有效干预措施来解决青少年的治疗差距，但资源有限、艾滋病毒高流行环境中的卫生系统在实施这些措施以实现疫情控制方面面临挑战。在此，我们描述了纳米比亚温得和克针对未实现病毒抑制的ALHIV接受抗逆转录病毒治疗的治疗差距所采取的卫生系统应对措施。
2023年6月至10月期间，我们在温得和克进行了一项定性描述性和探索性研究。有目的地选择了19名关键信息提供者进行访谈，他们从儿科艾滋病毒项目管理人员到医疗服务提供者不等。深入访谈进行了录音并逐字转录。转录本上传到ATLAS.ti并进行了主题分析。
四个主要主题阐明了与依从性和留存率相关的挑战以及以干预措施和支持项目形式出现的卫生系统应对措施。ALHIV面临的主要依从性和留存率挑战是心理健康问题、行为和药物相关挑战以及护理和社会支持不足。针对已确定挑战的卫生系统应对措施包括提供心理社会支持、同伴支持、优化治疗和护理以及采用有效的服务提供模式。确定的关键卫生系统支持要素包括具备足够能力的人力资源、高效的药物供应链系统、营造和维持有利于最佳护理的环境以及强大的监测系统，这些对于项目成功至关重要。
温得和克针对未实现病毒抑制的ALHIV剩余治疗差距的卫生系统应对措施多种多样，尽管基于证据，但似乎是孤立的。我们建议提供统一的多方面指导，整合心理社会、治疗、护理和同伴主导的支持，并加强以客户为中心的差异化服务提供模式，以服务未实现病毒抑制的青少年。
