Bullying and ART Nonadherence Among South African ALHIV: Effects, Risks, and Protective Factors.
Bullying and ART Nonadherence Among South African ALHIV: Effects, Risks, and Protective Factors.
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南非 ALHIV 中的欺凌和 ART 不依从：影响、风险和保护因素。
DOI：
10.1097/qai.0000000000002574
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Casale M
中科院分区：
文献类型：
--
作者：
Casale M
背景：鉴于青少年HIV相关死亡率较高，确定青少年接受抗逆转录病毒治疗(ART)的风险和保护因素是公共卫生的优先事项。一个值得进一步研究的领域是欺凌受害者、心理健康问题和青少年艾滋病病毒携带者(ALHIV)患者不遵守ART之间的关系。背景：本研究调查了(1)欺凌暴露与ART不依从性之间的直接纵向关系，以及通过心理困扰的间接关系；(2)在南非某卫生区53个公共卫生保健机构中，垂直和横向感染ALHIV的患者中，潜在的风险和可改变的保护因素调节了这些途径。方法：在2014-2017年间的两个时间点收集调查数据，其中ALHIV患者1046人(94%)。结果：欺负与不遵守之间存在显著的纵向关系，通过心理困扰间接作用于欺负[B=0.07；95%可信区间(CI)：(0.03~0.13)]。适度分析表明，处于欺负状态的年长青少年更容易不遵守行为[B=0.5 2；95%CI：(0.0 7~0.97)P<；0.0 5]，父母监督是缓冲欺负对不坚持行为间接影响的潜在保护因素[B=−0.2 2；95%CI：(−0.42至−0.0 2)P<；0.0 5]。结论：这些发现强调了针对欺负和心理困扰的干预措施的重要性，并加强父母监测，特别是在老年ALHIV患者。
Background:Identifying risk and protective factors for adolescent antiretroviral therapy (ART) adherence is a public health priority, given high HIV-related mortality in this population. An area that merits further investigation is the relationship between bullying victimization, mental health problems, and ART nonadherence among adolescents living with HIV (ALHIV). However, no known studies assess effects of bullying on adolescent nonadherence or risk and protective factors that could moderate this relationship.Setting:This study investigates (1) the direct longitudinal relationship between bullying exposure and ART nonadherence, and the indirect relationship via psychological distress, and (2) potential risk and modifiable protective factors moderating these pathways, among vertically and horizontally infected ALHIV who initiated treatment across 53 public health care facilities in a South African health district.Methods:Survey data were collected at 2 time points, between 2014 and 2017, with 1046 ALHIV (94% retention). Various mediation and moderated mediation models were run as part of a staged analysis approach.Results:A significant longitudinal relationship was found between bullying victimization and nonadherence, operating indirectly through psychological distress [B= 0.07; 95% confidence interval (CI):(0.03 to 0.13)]. Moderation analyses indicated that older adolescents exposed to bullying are more at risk of nonadherence [B= 0.52; 95% CI:(0.07 to 0.97) P< 0.05], and parental monitoring is a potential protective factor buffering indirect effects of bullying on nonadherence [B=− 0.22; 95% CI:(− 0.42 to− 0.02) P< 0.05].Conclusions:These findings underscore the importance of interventions that address bullying and psychological distress, and strengthen parental monitoring, particularly among older ALHIV.