Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?
Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?
复制标题
实现艾滋病毒治疗结果的公平：社会保护能否改善南非的青少年艺术遵守？
DOI：
10.1080/09540121.2016.1179008
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发表时间：
2016-03
期刊：
影响因子：
1.7
通讯作者：
Sherr L
中科院分区：
文献类型：
--
作者：
Cluver LD;Toska E;Orkin FM;Meinck F;Hodes R;Yakubovich AR;Sherr L
青少年抗逆转录病毒疗法依从性低与发病率、死亡率和艾滋病毒传播有关。审查发现没有有效的青少年依从性促进干预措施。社会保障已证明对青少年有益，并有可能提高抗逆转录病毒疗法的坚持率。这项研究探讨了协会的10个社会保障规定，坚持在一个大的社区为基础的样本艾滋病毒阳性的青少年。在2014-2015年，对南非东开普省卫生区53家政府医疗机构中所有10-19岁的ART启动者进行了追踪和访谈（n = 1175符合条件）。约90%的合格样本被纳入（n = 1059）。提供的社会保障是“现金/现金实物”：政府现金转移、粮食安全、学费/材料、学校供餐、衣服;以及“护理”：艾滋病毒支助小组、体育小组、合唱团/艺术小组、积极育儿和父母监督/监测。分析使用SPSS和STATA中的多变量回归、相互作用和边际效应模型，控制社会人口统计学、艾滋病毒和医疗保健相关协变量。结果显示，36%的人自我报告过去一周ART不依从（<95%）。不依从与机会性感染增加相关（p = 0.005，B 0.269，SD 0.09），并且在最后一次检测时可检测到病毒载量的可能性增加（>75拷贝/ml）（aOR 1.98，CI 1.1-3.45）。独立于协变量，三种社会保障规定与不依从减少相关：食物提供（aOR .57，CI .42-.76，p < .001）;艾滋病毒支持小组出席（aOR .60，CI .40-.91，p < .02）和父母/照顾者的高度监督（aOR .56，CI .43-.73，p < .001）。综合社会保障显示出附加效益。在没有社会保障的情况下，不遵守的比例为54%，有任何一种保障的比例为39- 41%，有任何两种社会保障的比例为27-28%，有所有三种社会保障的比例为18%。这些结果表明，提供社会保障，特别是“现金加护理”的组合，可以提高青少年的依从性。通过这一点，他们有可能改善生存和福祉，预防艾滋病毒传播，并促进艾滋病毒阳性青少年的治疗公平。
Low ART-adherence amongst adolescents is associated with morbidity, mortality and onward HIV transmission. Reviews find no effective adolescent adherence-promoting interventions. Social protection has demonstrated benefits for adolescents, and could potentially improve ART-adherence. This study examines associations of 10 social protection provisions with adherence in a large community-based sample of HIV-positive adolescents. All 10–19-year-olds ever ART-initiated in 53 government healthcare facilities in a health district of South Africa’s Eastern Cape were traced and interviewed in 2014–2015 (n = 1175 eligible). About 90% of the eligible sample was included (n = 1059). Social protection provisions were “cash/cash in kind”: government cash transfers, food security, school fees/materials, school feeding, clothing; and “care”: HIV support group, sports groups, choir/art groups, positive parenting and parental supervision/monitoring. Analyses used multivariate regression, interaction and marginal effects models in SPSS and STATA, controlling for socio-demographic, HIV and healthcare-related covariates. Findings showed 36% self-reported past-week ART non-adherence (<95%). Non-adherence was associated with increased opportunistic infections (p = .005, B .269, SD .09), and increased likelihood of detectable viral load at last test (>75 copies/ml) (aOR 1.98, CI 1.1–3.45). Independent of covariates, three social protection provisions were associated with reduced non-adherence: food provision (aOR .57, CI .42–.76, p < .001); HIV support group attendance (aOR .60, CI .40–.91, p < .02), and high parental/caregiver supervision (aOR .56, CI .43–.73, p < .001). Combination social protection showed additive benefits. With no social protection, non-adherence was 54%, with any one protection 39–41%, with any two social protections, 27–28% and with all three social protections, 18%. These results demonstrate that social protection provisions, particularly combinations of “cash plus care”, may improve adolescent adherence. Through this they have potential to improve survival and wellbeing, to prevent HIV transmission, and to advance treatment equity for HIV-positive adolescents.