Scaling a waterfall: a meta-ethnography of adolescent progression through the stages of HIV care in sub-Saharan Africa.
Scaling a waterfall: a meta-ethnography of adolescent progression through the stages of HIV care in sub-Saharan Africa.
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DOI：
10.7448/ias.20.1.21922
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发表时间：
2017-09-15
影响因子：
6
通讯作者：
Wringe A
中科院分区：
文献类型：
--
作者：
Williams S;Renju J;Ghilardi L;Wringe A
简介：观察性研究表明，在撒哈拉以南非洲的艾滋病毒护理“级联”中，感染艾滋病毒的青少年有相当大的流失，导致与感染艾滋病毒的成人或儿童相比死亡率更高。我们综合了关于促进或破坏撒哈拉以南非洲艾滋病毒感染青少年参与艾滋病毒服务的因素的定性研究证据。 方法：我们系统地检索了 5 个数据库，查找 2005 年至 2016 年间发表的符合预先定义的纳入标准的研究。我们使用元人种学方法从合格的研究中识别第一、第二和第三阶结构，并应用社会生态框架将我们的结果定位在不同影响水平上，并与艾滋病毒级联的每个阶段相关。 结果和讨论：我们确定了 3089 篇引用，其中 24 篇文章符合纳入条件。其中，17 个来自南部非洲，11 个来自东非。 6 项探讨了与 HIV 检测相关的问题，11 项探讨了治疗依从性，7 项涵盖了级联的多个阶段。出现了十二个三阶结构来解释青少年参与艾滋病毒护理。在过去十年中，耻辱是阻碍青少年与艾滋病毒护理互动的最显着因素。适应艾滋病毒生活的自我效能以及家庭或社交网络的支持是支持艾滋病毒护理和治疗计划的吸收和保留的关键推动因素。据报道，提供青少年友好型服务和卫生系统问题（例如提供高效、保密和舒适的服务）也可以推动持续的护理参与。个人层面的因素，包括过去的疾病经历、确定在社交场合管理服药的机制、财务（不稳定）稳定性以及未来愿望的存在/不存在，也影响了青少年艾滋病毒护理的参与。 结论：青少年最初和持续使用艾滋病毒护理经常受到个人问题的影响；尽管家庭、社区和卫生系统因素发挥了重要作用。干预措施应优先解决青少年的社会心理问题，以促进个人层面参与艾滋病毒护理，并最终降低死亡率。进一步的研究应探讨不同环境下护理联系和抗逆转录病毒治疗启动相关的问题，特别是随着“检测和治疗”政策的扩大。
Introduction: Observational studies have shown considerable attrition among adolescents living with HIV across the “cascade” of HIV care in sub-Saharan Africa, leading to higher mortality rates compared to HIV-infected adults or children. We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub-Saharan Africa. Methods: We systematically searched five databases for studies published between 2005 and 2016 that met pre-defined inclusion criteria. We used a meta-ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio-ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade. Results and discussion: We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third-order constructs emerged to explain adolescents’ engagement in HIV care. Stigma was the most salient factor impeding adolescents’ interactions with HIV care over the past decade. Self-efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent-friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual-level factors, including past illness experiences, identifying mechanisms to manage pill-taking in social situations, financial (in)stability and the presence/absence of future aspirations also shaped adolescents HIV care engagement. Conclusions: Adolescents’ initial and ongoing use of HIV care was frequently undermined by individual-level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual-level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as “test and treat” policies are scaled up.