Waterous Patricia, Chingono Rudo, Mackworth-Young Constance, Nyamayaro Chipo, Kandiye Faith Rutendo, Marambire Edson, Schellenberg Joanna, Mutsvangwa Junior, Chonzi Prosper, Kavenga Fungai, Ferrand Rashida, Kranzer Katharina, Bernays Sarah
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Biomedical Research and Training Institute, Harare, Zimbabwe.
PLOS Glob Public Health. 2024 Nov 15;4(11):e0003659. doi: 10.1371/journal.pgph.0003659. eCollection 2024.
Globally adolescents and young adults (AYA) with tuberculosis (TB) face unique challenges. Until recently they have received little attention and few tailored interventions exist. To improve TB outcomes in this population, there is a need to implement tailored interventions. However, limited research has been conducted about how to meet the needs of AYA with tuberculosis. In this paper we present the findings of a qualitative study to explore the needs of AYA with TB in Zimbabwe and to identify interventions to optimize their engagement in TB care.
We conducted two participatory workshops with 16 AYA, aged 10-24 years diagnosed with TB to explore their experiences of TB disease and treatment. Through subsequent interviews with 15 of the same AYA and with two other key stakeholder groups (health care providers n = 11 and policy makers n = 9), we sought to identify areas of convergence and divergence about what youth-orientated services and policies would be effective in Zimbabwe. Qualitative data were analyzed iteratively and thematically.
The findings are presented to align with four levels of a socio-ecological framework: individual, community, health system and policy. All three stakeholder groups highlighted the unmet mental health and TB literacy needs of AYA, which are particularly acute early in their TB care journey, as well as the imperative of engendering family support and securing the continuity of educational or employment opportunities during and after receiving TB care. There was a consensus that clinical services needed to become more youth-centered by extending training for health care providers and investing in peer-delivered psychosocial support. More broadly, there was also a strong consensus that adolescent-specific TB policies require further development and implementation, accompanied by community-based TB education and awareness campaigns to emphasize the curability of TB and to reduce TB related stigma.
There is much to be done to improve TB care for AYA. We found that there is need for alignment on where investment is needed to support the development of context-appropriate and effective interventions. There is an opportunity to benefit from translational learning from other successful approaches, such as HIV, within the region. Implementation of evidence-based interventions and youth-friendly policies and programs are much needed to improve outcomes for AYA with TB.
在全球范围内，患有结核病（TB）的青少年和青年面临着独特的挑战。直到最近，他们很少受到关注，而且几乎没有针对性的干预措施。为了改善这一人群的结核病治疗效果，有必要实施针对性的干预措施。然而，关于如何满足患有结核病的青少年和青年的需求，相关研究有限。在本文中，我们展示了一项定性研究的结果，该研究旨在探索津巴布韦患有结核病的青少年和青年的需求，并确定优化他们参与结核病治疗的干预措施。
我们与16名年龄在10 - 24岁、被诊断患有结核病的青少年和青年举办了两次参与式工作坊，以探讨他们患结核病及接受治疗的经历。通过随后对其中15名青少年和青年以及另外两个关键利益相关者群体（11名医疗服务提供者和9名政策制定者）的访谈，我们试图确定在津巴布韦哪些以青年为导向的服务和政策会有效，找出各方观点的异同之处。对定性数据进行了反复的主题分析。
研究结果按照社会生态框架的四个层面呈现：个人、社区、卫生系统和政策。所有三个利益相关者群体都强调了青少年和青年未得到满足的心理健康及结核病知识需求，这些需求在他们结核病治疗过程的早期尤为突出，同时还强调了在结核病治疗期间及之后获得家庭支持以及确保教育或就业机会连续性的必要性。大家达成共识，临床服务需要通过加强对医疗服务提供者的培训并投资于同伴提供的心理社会支持，变得更加以青年为中心。更广泛地说，也强烈达成共识，即需要进一步制定和实施针对青少年的结核病政策，并开展基于社区的结核病教育和宣传活动，以强调结核病的可治愈性并减少与结核病相关的耻辱感。
在改善对青少年和青年的结核病治疗方面，仍有许多工作要做。我们发现，需要在支持制定因地制宜且有效的干预措施所需的投资方向上达成一致。有机会借鉴该地区其他成功方法（如艾滋病毒防治方面）的转化性经验。迫切需要实施基于证据的干预措施以及对青年友好的政策和项目，以改善患有结核病的青少年和青年的治疗效果。
