Sam-Agudu Nadia Adjoa, Adirieje Chibueze, Agwu Allison Lorna, Rakhmanina Natella
International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
Department of Paediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
Pan Afr Med J. 2024 Oct 23;49:53. doi: 10.11604/pamj.2024.49.53.45322. eCollection 2024.
Recent approvals of long-acting (LA) antiretroviral treatment (ART) support an innovative alternative to daily oral pills that can improve adherence and treatment outcomes among adolescents and youth (AY) with HIV. We solicited stakeholder feedback on the implementation of LA ART for AY in low-and middle-income countries (LMICs) through a consensus-building forum at the 2022 International Workshop on HIV and Adolescence. We used the nominal group technique to generate, record, discuss, vote on, and rank perceived barriers and facilitators to implementing LA ART for AY. All in-person attendees were invited to participate and were assigned to six groups, each representing an intentional mix of AY, clinicians, researchers, program implementers, and policymakers. We collected self-reported de-identified demographics and group rankings of barriers and facilitators. Responses were coded and categorized using the social-ecological model's five levels of influence. One hundred and thirty-seven (137) Workshop delegates (67.9% male, 27.7% female; 0.7% non-binary, and 46.7% less than 35 years old) participated in the group discussions. A large proportion of participants (51.9%) reported working in public health/program implementation. Most participants (88.4%) were from and/or worked in the African region. We identified 55 barriers and 48 facilitators of LA ART implementation and ranked them in social-ecological categories of public policy, community, institutional/organizational, interpersonal, and individual levels. The highest number of ranked barriers was at the institutional/organizational level. The themes of "equitable access" and "choices of ART" were cross-cutting across individual and interpersonal levels. Other cross-cutting themes were the "cost of LA ART" and the "need for funding and sustainability of LA ART programs". Proposed facilitators addressed identified barriers at each social-ecological level of influence and emphasized peer engagement. Our nominal groups identified key barriers and proposed facilitators at five different social-ecological levels, which can inform implementation science-guided design and equitable implementation of youth-centered LA ART in LMICs and globally.
长效抗逆转录病毒疗法（ART）近期获批，为每日口服药物提供了一种创新替代方案，有望改善感染艾滋病毒的青少年的依从性和治疗效果。我们通过2022年艾滋病毒与青少年国际研讨会的共识建立论坛，征求了中低收入国家（LMICs）青少年长效抗逆转录病毒疗法实施方面的利益相关者反馈。我们使用名义小组技术来生成、记录、讨论、投票并对青少年长效抗逆转录病毒疗法实施的感知障碍和促进因素进行排名。所有亲自参会者均被邀请参与，并被分成六个小组，每个小组代表青少年、临床医生、研究人员、项目实施者和政策制定者的有意混合。我们收集了自我报告的匿名人口统计信息以及障碍和促进因素的小组排名。使用社会生态模型的五个影响层面进行编码和分类。137名研讨会代表（67.9%为男性，27.7%为女性；0.7%为非二元性别，46.7%年龄小于35岁）参与了小组讨论。很大一部分参与者（51.9%）报告从事公共卫生/项目实施工作。大多数参与者（88.4%）来自非洲地区和/或在非洲地区工作。我们确定了55个长效抗逆转录病毒疗法实施的障碍和48个促进因素，并将它们按照公共政策、社区、机构/组织、人际和个人层面的社会生态类别进行排名。排名最高的障碍数量出现在机构/组织层面。“公平获取”和“抗逆转录病毒疗法选择”的主题贯穿个人和人际层面。其他贯穿各层面的主题是“长效抗逆转录病毒疗法的成本”以及“长效抗逆转录病毒疗法项目的资金需求和可持续性”。提议的促进因素在每个社会生态影响层面解决了已确定的障碍，并强调了同伴参与。我们的名义小组确定了五个不同社会生态层面的关键障碍并提出了促进因素，这可为中低收入国家及全球以青少年为中心的长效抗逆转录病毒疗法的实施科学指导设计和公平实施提供参考。
