Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa.
Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa.
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DOI：
10.1097/qad.0000000000001795
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发表时间：
2018-05-15
期刊：
影响因子：
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通讯作者：
Sherr L
中科院分区：
文献类型：
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作者：
Cluver L;Meinck F;Toska E;Orkin FM;Hodes R;Sherr L
艾滋病毒阳性青少年的抗逆转录病毒治疗依从性低，因此死亡率，发病率和病毒耐药性的风险增加。尽管非洲区域暴力侵害儿童行为的发生率很高，但没有已知的研究测试对艾滋病毒阳性青少年的影响。我们研究了ART依从性与青少年暴力受害的关系，包括照顾者、教师、同龄人、社区成员和医疗保健提供者。对HIV阳性青少年进行了访谈（n = 1060），并收集了临床生物标志物数据。 我们在180个南非社区的53个诊所（达到90.1%）中对所有10-19奥尔兹进行了ART。使用序贯多变量logistic回归分析研究了不依从和九种暴力类型之间的关联。用回归和边际效应检验了交互效应和累加效应。过去一周自我报告的ART不依从率为36%。不依从与病毒学失败（OR 2.3，CI 1.4-3.8）和症状性肺结核（OR 1.49，CI 1.18-2.05）密切相关。四种暴力类型与不依从性独立相关：照顾者的身体虐待（OR 1.5，CI 1.1-2.1）;目睹家庭暴力（OR 1.8，CI 1.22-2.66）;教师暴力（OR 1.51，CI 1.16-1.96）和医护人员的口头伤害（OR 2.15，CI 1.59-2.93）。过去一周的不遵守从25%上升到73.5%，没有暴力与四种类型的暴力暴露。家庭、学校和诊所的暴力暴露是青少年抗逆转录病毒治疗不依从的主要和累积风险。预防、缓解和保护服务可能对艾滋病毒阳性青少年的健康和生存至关重要。
HIV-positive adolescents have low-ART adherence, with consequent increased risks of mortality, morbidity, and viral resistance. Despite high rates of violence against children in the Africa region, no known studies have tested impacts on HIV-positive adolescents. We examine associations of ART adherence with adolescent violence victimization by caregivers, teachers, peers, community members, and healthcare providers. HIV-positive adolescents were interviewed (n = 1060), and clinic biomarker data collected. We sampled all 10–19-year olds ever ART-initiated within 53 clinics in 180 South African communities (90.1% reached). Analyses examined associations between nonadherence and nine violence types using sequential multivariate logistic regressions. Interactive and additive effects were tested with regression and marginal effects. Past-week self-reported ART nonadherence was 36%. Nonadherence correlated strongly with virologic failure (OR 2.3, CI 1.4–3.8) and symptomatic pulmonary tuberculosis (OR 1.49, CI 1.18–2.05). Four violence types were independently associated with nonadherence: physical abuse by caregivers (OR 1.5, CI 1.1–2.1); witnessing domestic violence (OR 1.8, CI 1.22–2.66); teacher violence (OR 1.51, CI 1.16–1.96,) and verbal victimization by healthcare staff (OR 2.15, CI 1.59–2.93). Past-week nonadherence rose from 25% with no violence to 73.5% with four types of violence exposure. Violence exposures at home, school, and clinic are major and cumulating risks for adolescent antiretroviral nonadherence. Prevention, mitigation, and protection services may be essential for the health and survival of HIV-positive adolescents.