Scaling up peer-led community-based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success
Scaling up peer-led community-based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success
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DOI：
10.1002/jia2.25570
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发表时间：
2020-09-01
影响因子：
6
通讯作者：
Mavhu, Webster
中科院分区：
文献类型：
--
作者：
Bernays, Sarah;Tshuma, Maureen;Mavhu, Webster
简介 艾滋病毒感染者 (ALHIV) 青少年的病毒抑制率较低，表明迫切需要大规模更有效的支持。同伴支持的提供引起了相当大的热情，因为它有可能改善复杂的社会和关系挑战，而这些挑战是次优依从性的基础。人们对这对年轻同伴支持者本身的影响知之甚少，而这正是本文的重点。方法 我们提出了 Zvandiri 试验的定性结果，该试验调查了同伴支持干预对津巴布韦受益人（ALHIV，13 至 19 岁）病毒载量的影响。 Zvandiri 的同伴支持者年龄在 18 至 24 岁之间，被称为社区青少年治疗支持者 (CATS)，他们自己也感染了艾滋病毒。 2018 年底，我们对 17 名 CATS 进行了个人深度访谈，探讨了他们提供同伴支持的经验以及他们自己的支持需求。使用主题分析对访谈进行迭代分析。结果 CATS 报告称，成为同伴支持者可以改善他们自己的依从行为，并有助于提高自我价值感。 CATS 之间的社会联系是一种安慰的源泉，使他们能够培养应对工作中具有挑战性的方面的技能。确定了两个重大挑战。首先，他们的工作可能会揭示他们的艾滋病毒状况。其次，管理这项关怀工作的情感劳动；鉴于受益人需求的复杂性通常反映了他们自己困难生活的情况。 CATS 相互提供的支持以及成人导师的持续监督缓解了这两项挑战。他们是否认为自己的角色通过他们收到的薪酬以及在卫生系统内得到了适当的重视，存在差异。大家一致认为，他们的经历意味着他们从 CATS 毕业后将拥有可转移的技能，从而提高他们的就业能力。结论 他们的经历说明了成为 CATS 的优势和机会。为了尽量减少潜在的伤害，至关重要的是确保他们感到自己的角色受到重视，这可以通过提供适当的薪酬、认可和尊重来证明，并通过持续的培训和指导持续投资于持续的支持。
Introduction Low rates of viral suppression among adolescents living with HIV (ALHIV) indicate that more effective support is urgently required at scale. The provision of peer support has generated considerable enthusiasm because it has the potential to ameliorate the complex social and relational challenges which underpin suboptimal adherence. Little is known about the impact on young peer supporters themselves, which is the focus of this paper. Methods We present qualitative findings from the Zvandiri trial investigating the impact of a peer support intervention on the viral load for beneficiaries (ALHIV, aged 13 to 19 years) in Zimbabwe. The Zvandiri peer supporters aged 18 to 24 years, known as community adolescent treatment supporters (CATS), are themselves living with HIV. Individual in-depth interviews were conducted in late 2018 with 17 CATS exploring their experiences of delivering peer support and their own support needs. Interviews were analysed iteratively using thematic analysis. Results The CATS reported that being peer supporters improved their own adherence behaviour and contributed to an improved sense of self-worth. The social connections between the CATS were a source of comfort and enabled them to develop skills to manage the challenging aspects of their work. Two substantial challenges were identified. First, their work may reveal their HIV status. Second, managing the emotional labour of this caring work; given how commonly the complexity of the beneficiaries' needs mirrored the circumstances of their own difficult lives. Both challenges were ameliorated by the support the CATS provided to each other and ongoing supervision from the adult mentor. There was variation in whether they felt their roles were appropriately valued through the remuneration they received and within the health system. There was a consensus that their experience meant that they would graduate from being a CATS with transferable skills that could enhance their employability. Conclusions Their experiences illustrate the advantages and opportunities of being a CATS. To minimize potential harms, it is vital to ensure that they feel valued in their role, which can be demonstrated by the provision of appropriate remuneration, recognition and respect, and that there is continued investment in ongoing support through ongoing training and mentoring.