It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV.
It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV.
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DOI：
10.1371/journal.pone.0248018
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Bernays S
中科院分区：
文献类型：
--
作者：
Wogrin C;Willis N;Mutsinze A;Chinoda S;Verhey R;Chibanda D;Bernays S
与其他年龄组相比，感染艾滋病毒的青少年的治疗效果较差，包括病毒抑制率较低。新出现的证据表明，精神健康的改善和坚持服药的增加之间存在联系。加强对精神卫生的关注可以支持病毒抑制率的提高。在撒哈拉以南非洲，精神卫生保健的临床服务极为有限。需要更多的机制来解决这一群体未得到满足的心理健康需求。我们考虑了社区同伴支持者的作用，这是一个与青少年一起大规模运作的骨干，可以在提供心理健康的基础支持方面发挥作用。作为随机对照试验（Zvandiri-Friendship Bench试验）的一部分，我们进行了定性研究，以探索同伴支持者参与在津巴布韦提供同伴主导的心理健康干预的经验。在试验结束时，我们与来自10个干预地区的20名同伴支持者（18-24岁）进行了两次焦点小组讨论，并录音了200名同伴支持者每月的病例回顾。对这些数据进行了专题分析，以探讨同伴支持者如何考虑到客户提出的问题，以及他们自己在提供心理健康支持方面需要什么。数据集中反映的同伴支持模式的一个主要优势是，它使青少年能够与同伴支持者公开讨论他们的问题，相信由于他们与艾滋病毒的生活经历相似，相互信任和理解。同伴支持者有潜在的风险，包括参与解决关系和结构上复杂的问题，并感到有责任，这需要相当的监督。为支持这一骨干队伍，需要具备以下关键要素：明确界定可管理的心理健康支持提供范围；对复杂病例有强有力的分诊和转诊制度；支持照顾者参与的机制；在培训和持续监督方面的持续投资。扩大同伴支持以明确包括对精神健康的关注具有巨大的潜力。从这一实证研究中，我们制定了一个核心考虑因素和原则框架（信任框架），以指导实施适当的支持性基础设施，以增加机会并降低风险。
Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18–24) from across 10 intervention districts and audio recorded 200 of the peer supporters’ monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.
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