Velloza Jennifer, Ndimande-Khoza Nomhle, Mills Lisa, Poovan Nicole, Adler Aliza, Sherwin Elizabeth B, Mathew Carrie, Sokhela Zinhle, Verhey Ruth, Chibanda Dixon, Gandhi Monica, Celum Connie, Delany-Moretlwe Sinead
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA.
Department of Global Health, University of Washington, Seattle, Washington, USA.
J Int AIDS Soc. 2025 Sep;28(9):e70037. doi: 10.1002/jia2.70037.
Adolescent girls and young women (AGYW) at risk of HIV frequently have symptoms of common mental disorders (CMDs), which are associated with lower pre-exposure prophylaxis (PrEP) adherence. We conducted a pilot hybrid effectiveness-implementation trial (CHOMA) to evaluate whether an evidence-based mental health intervention adapted for PrEP delivery ("Youth Friendship Bench SA") could address CMD and PrEP adherence among South African AGYW.
CHOMA was conducted in Johannesburg from April 2023 to February 2024. We enrolled AGYW (18-25 years) who were already on or willing to initiate PrEP and had CMD symptoms (Self-Reporting Questionnaire 20-item [SRQ-20]≥7). Participants were randomized to our Youth Friendship Bench SA intervention (five problem-solving sessions with a lay counsellor, one group session) or standard-of-care CMD services (brief CMD assessment, referral). Counselling sessions occurred at enrolment and Weeks 2, 4, 8 and 12. Co-primary outcomes were PrEP adherence (positive result on a urine tenofovir assay) and reduced CMD symptoms (SRQ-20<7) at Week 12 and, secondarily, Week 4. We used Poisson regression to assess intervention effects and summarized responses to three validated scales assessing intervention acceptability, appropriateness and feasibility (ranges: 1-4).
Of 116 AGYW enrolled, the median SRQ-20 score was 9. We retained 69% through Week 12. Of 57 intervention participants, 64.9% (N = 37) received four or more sessions. At Week 4, 29/36 (80.6%) participants in the intervention and 25/41 (61.0%) in the standard-of-care had recent PrEP use (RR = 1.40; 95% CI = 1.03-1.89; p = 0.03), but this was not sustained through Week 12 (RR = 0.88; 95% CI = 0.64-1.22; p = 0.44). Enrolment SRQ-20 score was not associated with Week 12 PrEP adherence or retention. CMD symptoms did not differ by arm at Week 4 or 12, although the proportion with SRQ-20 scores >7 decreased overall between Weeks 4 (54.5%, 42/77) and 12 (35.0%, 28/80; p = 0.02). Median acceptability, appropriateness and feasibility scores were 3.50, 3.75 and 3.25, respectively.
The intervention improved PrEP adherence at Week 4, although the effect was not durable to Week 12, possibly due to retention challenges. Reductions in CMD symptoms were seen in both arms. Findings suggest different mental health and PrEP support interventions may be needed to improve integrated service delivery among AGYW.
面临感染艾滋病毒风险的青春期女孩和年轻女性（AGYW）经常出现常见精神障碍（CMD）症状，这与较低的暴露前预防（PrEP）依从性有关。我们开展了一项试点混合有效性-实施试验（CHOMA），以评估一种为PrEP实施而调整的循证心理健康干预措施（“南非青年友谊咨询台”）是否能解决南非AGYW中的CMD问题和PrEP依从性问题。
CHOMA于2023年4月至2024年2月在约翰内斯堡进行。我们招募了已在接受或愿意开始接受PrEP且有CMD症状（20项自评问卷[SRQ-20]≥7）的AGYW（18 - 25岁）。参与者被随机分配到我们的南非青年友谊咨询台干预组（与一名非专业咨询师进行五次解决问题的 sessions，一次小组session）或标准护理CMD服务组（简短的CMD评估、转诊）。咨询sessions在入组时以及第2、4、8和12周进行。共同主要结局是第12周时的PrEP依从性（尿替诺福韦检测呈阳性结果）和CMD症状减轻（SRQ-20<7），次要结局是第4周时的情况。我们使用泊松回归来评估干预效果，并总结对三个评估干预可接受性、适宜性和可行性的有效量表的反应（范围：1 - 4）。
在招募入组的116名AGYW中，SRQ-20得分中位数为9。到第12周时我们保留了69%的参与者。在57名干预组参与者中，64.9%（N = 37）接受了四次或更多次sessions。在第4周时，干预组36名参与者中有29名（80.6%）近期使用了PrEP，标准护理组41名参与者中有25名（61.0%）近期使用了PrEP（相对风险 = 1.40；95%置信区间 = 1.03 - 1.89；p = 0.03），但到第12周时这种情况未持续（相对风险 = 0.88；95%置信区间 = 0.64 - 1.22；p = 0.44）。入组时的SRQ-20得分与第12周时的PrEP依从性或保留率无关。在第4周或第12周时，两组的CMD症状没有差异，尽管SRQ-20得分>7的比例在第4周（54.5%，42/77）和第12周（35.0%，28/80；p = 0.02）之间总体有所下降。可接受性、适宜性和可行性得分中位数分别为3.50、3.75和3.25。
该干预措施在第4周时提高了PrEP依从性，尽管到第12周时效果未持久，可能是由于保留率方面的挑战。两组的CMD症状均有所减轻。研究结果表明，可能需要不同的心理健康和PrEP支持干预措施来改善AGYW中的综合服务提供情况。
