Improving lives by accelerating progress towards the UN Sustainable Development Goals for adolescents living with HIV: a prospective cohort study
Improving lives by accelerating progress towards the UN Sustainable Development Goals for adolescents living with HIV: a prospective cohort study
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DOI：
10.1016/s2352-4642(19)30033-1
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发表时间：
2019-04-01
影响因子：
36.4
通讯作者：
Sherr, Lorraine
中科院分区：
文献类型：
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作者：
Cluver, Lucie D.;Orkin, F. Mark;Sherr, Lorraine
背景 低收入和中等收入国家 (LMIC) 在实现联合国针对弱势青少年的可持续发展目标 (SDG) 方面面临重大挑战。我们的目的是测试联合国开发计划署提出的发展加速器方法——能够在多个可持续发展目标方面取得进展的规定——以及加速器之间的协同作用，以在南非高度弱势的青少年群体中实现与可持续发展目标一致的目标。方法我们对南非10-19岁艾滋病毒感染者的基线（2014-15）和18个月随访（2016-17）的临床记录进行标准化访谈并提取纵向数据。南非东开普省。我们使用标准化工具来衡量 11 个与可持续发展目标一致的目标——抗逆转录病毒治疗依从性、良好的心理健康、不使用药物、艾滋病毒护理保留、入学率、学业进步、无性虐待、无高危性行为、无暴力行为、无社区暴力以及无情感或身体虐待。我们还评估了六个假设的发展加速器的基线和后续接收情况——政府向家庭的现金转移、安全学校（即没有教师或学生暴力）、免费学校、育儿支持、免费学校膳食和支持小组。所有规定与可持续发展目标一致的目标的关联均在多变量路径模型中联合评估，控制基线结果以及社会人口统计学和艾滋病毒相关协变量，并针对多重结果测试进行调整。通过边际效应模型测试累积效应。调查结果对 1176 名符合条件的青少年中的 1063 名（90%）进行了访谈。三项规定被证明是发展加速器。育儿支持与良好的心理健康相关（比值比 2.13，95% CI 1.43-3.15，p
Background Low-income and middle-income countries (LMICs) face major challenges in achieving the UN's Sustainable Development Goals (SDGs) for vulnerable adolescents. We aimed to test the UN Development Programme's proposed approach of development accelerators-provisions that lead to progress across multiple SDGs-and synergies between accelerators on achieving SDG-aligned targets in a highly vulnerable group of adolescents in South Africa.Methods We did standardised interviews and extracted longitudinal data from clinical records at baseline (2014-15) and 18-month follow-up (2016-17) for adolescents aged 10-19 years living with HIV in the Eastern Cape province of South Africa. We used standardised tools to measure 11 SDG-aligned targets-antiretroviral therapy adherence, good mental health, no substance use, HIV care retention, school enrolment, school progression, no sexual abuse, no high-risk sex, no violence perpetration, no community violence, and no emotional or physical abuse. We also assessed receipt at both baseline and follow-up of six hypothesised development accelerators-government cash transfers to households, safe schools (ie, without teacher or student violence), free schools, parenting support, free school meals, and support groups. Associations of all provisions with SDG-aligned targets were assessed jointly in a multivariate path model, controlling for baseline outcomes and sociodemographic and HIV-related covariates, and adjusted for multiple outcome testing. Cumulative effects were tested by marginal effects modelling.Findings 1063 (90%) of 1176 eligible adolescents were interviewed. Three provisions were shown to be development accelerators. Parenting support was associated with good mental health (odds ratio 2.13, 95% CI 1.43-3.15, p