Clinic and care: associations with adolescent antiretroviral therapy adherence in a prospective cohort in South Africa.
Clinic and care: associations with adolescent antiretroviral therapy adherence in a prospective cohort in South Africa.
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DOI：
10.1097/qad.0000000000002882
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发表时间：
2021-07-01
期刊：
影响因子：
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通讯作者：
Sherr L
中科院分区：
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作者：
Cluver L;Shenderovich Y;Toska E;Rudgard WE;Zhou S;Orkin M;Haghighat R;Chetty AN;Kuo C;Armstrong A;Sherr L
补充数字内容可在文本青少年抗逆转录病毒治疗（ART）坚持仍然非常低。我们缺乏在诊所和护理环境中测试保护因素的研究。在基线和18个月随访时（2014-2015年，2015-2016年），对南非东开普省的一个艾滋病毒感染青少年前瞻性队列（样本n =969，55%为女孩，基线平均年龄13.6岁）进行了访谈。 我们追踪了52个政府卫生机构中所有开始接受治疗的青少年（90%的接受率，93%的18个月保留率，1.2%的死亡率）。收集临床记录;由受过训练的数据收集者用青少年选择的语言进行标准化问卷调查。使用Probit内-间回归和平均调整概率计算来检查治疗和临床因素与依从性的关联，控制家庭结构，社会经济和HIV因素。过去一周的ART依从性为66%（基线），65%（随访），根据子样本中的病毒载量进行验证。三个因素的个体内变化与依从性的改善相关：没有身体和情感暴力（调整后的依从性概率增加12.1个百分点，P <0.001），感知医疗保健保密性的改善（7.1个百分点，P <0.04）和更短的前往诊所的旅行时间（13.7个百分点，P <0.02）。 综合而言，暴力预防、旅行时间和保密性的改善与81%的抗逆转录病毒治疗依从性相关，而这三个方面的恶化与47%的依从性相关。感染艾滋病毒的青少年在家里需要安全，在可获得的诊所里需要感到安全，不会受到耻辱。这将需要卫生和儿童保护系统之间的积极合作，并利用有效的暴力预防干预措施。
Supplemental Digital Content is available in the text Adolescent antiretroviral treatment (ART) adherence remains critically low. We lack research testing protective factors across both clinic and care environments. A prospective cohort of adolescents living with HIV (sample n = 969, 55% girls, baseline mean age 13.6) in the Eastern Cape Province in South Africa were interviewed at baseline and 18-month follow-up (2014–2015, 2015–2016). We traced all adolescents ever initiated on treatment in 52 government health facilities (90% uptake, 93% 18-month retention, 1.2% mortality). Clinical records were collected; standardized questionnaires were administered by trained data collectors in adolescents’ language of choice. Probit within-between regressions and average adjusted probability calculations were used to examine associations of caregiving and clinic factors with adherence, controlling for household structure, socioeconomic and HIV factors. Past-week ART adherence was 66% (baseline), 65% (follow-up), validated against viral load in subsample. Within-individual changes in three factors were associated with improved adherence: no physical and emotional violence (12.1 percentage points increase in adjusted probability of adherence, P < 0.001), improvement in perceived healthcare confidentiality (7.1 percentage points, P < 0.04) and shorter travel time to the clinic (13.7 percentage points, P < 0.02). In combination, improvement in violence prevention, travel time and confidentiality were associated with 81% probability of ART adherence, compared with 47% with a worsening in all three. Adolescents living with HIV need to be safe at home and feel safe from stigma in an accessible clinic. This will require active collaboration between health and child protection systems, and utilization of effective violence prevention interventions.