Integrated psychosocial, economic strengthening, and clinical service-delivery to improve health and resilience of adolescents living with HIV and their caregivers: Findings from a prospective cohort study in Zambia.
Integrated psychosocial, economic strengthening, and clinical service-delivery to improve health and resilience of adolescents living with HIV and their caregivers: Findings from a prospective cohort study in Zambia.
复制标题
DOI：
10.1371/journal.pone.0243822
复制
发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Kayeyi N
中科院分区：
文献类型：
--
作者：
Rosen JG;Phiri L;Chibuye M;Namukonda ES;Mbizvo MT;Kayeyi N
儿童和青少年是赞比亚艾滋病毒流行中深受影响的群体。为了评估通过赞比亚家庭 (ZAMFAM) 项目向受艾滋病毒影响的家庭提供综合心理社会、经济强化和临床服务的情况，一项前瞻性队列研究比较了 ZAMFAM 受益者与非受益者的社会经济、心理社会和健康结果。 2017 年 7 月至 10 月，从中部省份（ZAMFAM 实施地点）和东部省份（非干预地点）招募了 544 名 5-17 岁的艾滋病毒感染者 (ALHIV) 青少年及其成年照顾者。基线和一年随访的结构化访谈评估了家庭特征、社会经济福祉和卫生服务利用情况。使用广义估计方程的泊松回归测量了关键健康和社会经济指标的一年变化，并将 ZAMFAM 受益者与非受益者进行了比较。总体而言，494 个家庭完成了两轮评估（保留率：91%） 在 ALHIV 中，随着时间的推移，当前抗逆转录病毒治疗的使用有所改善（调整后患病率比 [aPRR] = 1.06，95% 置信区间 [95% CI]：1.01–1.11），并且非家庭劳动力减少（aPRR = 0.44，95% CI： ZAMFAM 受益人中的 (0.20–0.99) 明显大于非受益人。对于护理人员来说，接受 ZAMFAM 服务与 HIV 相关耻辱感显着减少（aPRR = 0.49，95% CI：0.28–0.88）以及社区对 HIV 的消极态度（aPRR = 0.77，95% CI：0.62–0.96）相关。护理人员支付意外费用（aPRR = 1.54，95% CI：1.17–2.04）和食品相关费用（aPRR = 1.48，95% CI：1.16–1.90）以及家庭支出方面的共同决策权（aPRR = 1.41，95% CI：1.04–1.93）和ZAMFAM 受益人自我报告的良好或非常良好的健康状况（aPRR = 1.46，95% CI：1.14–1.87）也显着更大。在接受 ZAMFAM 服务的家庭中，护理人员的经济能力显着改善，而 ALHIV 患者的健康或福祉几乎没有变化。像 ZAMFAM 这样的综合服务提供方法可能会在短期内带来明显的社会经济改善。鼓励加强以社区为基础的 ALHIV 心理社会和健康支持。
Children and youth are profoundly impacted groups in Zambia’s HIV epidemic. To evaluate delivery of integrated psychosocial, economic strengthening, and clinical services to HIV-affected households through the Zambia Family (ZAMFAM) Project, a prospective cohort study compared socio-economic, psychosocial, and health outcomes among ZAMFAM beneficiaries to non-beneficiaries. In July–October 2017, 544 adolescents living with HIV (ALHIV) aged 5–17 years and their adult caregivers were recruited from Central (ZAMFAM implementation sites) and Eastern (non-intervention sites) Provinces. Structured interviews at baseline and one-year follow-up assessed household characteristics, socio-economic wellbeing, and health service utilization. Poisson regression with generalized estimating equations measured one-year changes in key health and socio-economic indicators, comparing ZAMFAM beneficiaries to non-beneficiaries. Overall, 494 households completed two rounds of assessment (retention rate: 91%) Among ALHIV, improvements in current antiretroviral therapy use over time (Adjusted Prevalence Rate Ratio [aPRR] = 1.06, 95% Confidence Interval [95% CI]: 1.01–1.11) and reductions in non-household labor (aPRR = 0.44, 95% CI: 0.20–0.99) were significantly larger among ZAMFAM beneficiaries than non-beneficiaries. For caregivers, receiving ZAMFAM services was associated with significant reductions in HIV-related stigma (aPRR = 0.49, 95% CI: 0.28–0.88) and perceived negative community attitudes towards HIV (aPRR = 0.77, 95% CI: 0.62–0.96). Improvements in caregiver capacity to pay for unexpected (aPRR = 1.54, 95% CI: 1.17–2.04) and food-related expenses (aPRR = 1.48, 95% CI: 1.16–1.90), as well as shared decision-making authority in household spending (aPRR = 1.41, 95% CI: 1.04–1.93) and self-reported good or very good health status (aPRR = 1.46, 95% CI: 1.14–1.87), were also significantly larger among ZAMFAM beneficiaries. Significant improvements in caregivers’ financial capacity were observed among households receiving ZAMFAM services, with few changes in health or wellbeing among ALHIV. Integrated service-delivery approaches like ZAMFAM may yield observable socio-economic improvements in the short-term. Strengthening community-based delivery of psychosocial and health support to ALHIV is encouraged.
登录
查看更多内容
DOI：
10.1080/09540121.2017.1371667
发表时间：
2018-01-01
影响因子：
1.7
作者：
Bezabih, Tsegazeab;Weiser, S. D.;Grede, Nils
通讯作者：
Grede, Nils
影响因子：
3
作者：
Embleton, Lonnie;Ayuku, David;Braitstein, Paula
通讯作者：
Braitstein, Paula
影响因子：
4.4
作者：
MacDonell, Karen;Naar-King, Sylvie;Huszti, Heather;Belzer, Marvin
通讯作者：
Belzer, Marvin
DOI：
10.1080/17290376.2016.1230072
发表时间：
2016-01-01
影响因子：
1.1
作者：
Kakuhikire, Bernard;Suquillo, Diego;Tsai, Alexander C.
通讯作者：
Tsai, Alexander C.
DOI：
10.1111/j.1469-7610.2007.01757.x
发表时间：
2007-08-01
影响因子：
7.6
作者：
Cluver, Lucie;Gardner, Frances;Operario, Don
通讯作者：
Operario, Don