A group-based mental health intervention for young people living with HIV in Tanzania: results of a pilot individually randomized group treatment trial
A group-based mental health intervention for young people living with HIV in Tanzania: results of a pilot individually randomized group treatment trial
复制标题
DOI：
10.1186/s12889-020-09380-3
复制
发表时间：
2020-09-04
影响因子：
4.5
通讯作者：
O'Donnell, Karen E.
中科院分区：
文献类型：
--
作者：
Dow, Dorothy E.;Mmbaga, Blandina T.;O'Donnell, Karen E.
背景：越来越多的青年人感染艾滋病毒（YPLWH）面临未解决的心理健康挑战。这些挑战与抗逆转录病毒治疗依从性差和高死亡率有关。很少有循证精神卫生干预措施可以改善艾滋病毒感染者的结局。方法：本试验组治疗试验对坦桑尼亚两个临床站点的YPLWH进行随机分组，评估心理健康干预措施Sauti ya Vijana （SYV; The Voice of Youth）的可接受性、可行性和初步有效性，并将其与当地标准护理（SOC）进行比较，以提高抗逆转录病毒治疗的依从性和病毒学抑制。纳入的YPLWH年龄为12-24岁，在基线和6个月（干预后）对心理健康和耻辱感问卷、自我报告的依从性、客观依从性测量（头发中的抗逆转录病毒药物浓度）和HIV RNA进行了回应。评估可行性和可接受性，并通过使用混合效应模型比较两组之间的结果来评估潜在的有效性。结果2016年6月至2017年7月，共有128名YPLWH入组；105例随机分组，93例（55例SYV组）在6个月后随访，因此纳入本分析。平均年龄18.1岁；女性占51%；84%在围产期感染艾滋病毒。干预课程的出勤率为86%；6个月随访率为88%，对方案的忠实度接近100%。探索性有效性分析表明，自我报告的依从性提高了7.3个百分点（95% CI: 2.2, 12.3）；与SOC相比，SYV组所有ART浓度值的总标准差增加了0.17个单位（95% CI: -0.52, 0.85）。病毒抑制率（HIV RNA）
BackgroundIncreasing numbers of young people living with HIV (YPLWH) have unaddressed mental health challenges. Such challenges are associated with poor antiretroviral therapy (ART) adherence and high mortality. Few evidence-based mental health interventions exist to improve HIV outcomes among YPLWH.MethodsThis pilot group treatment trial individually randomized YPLWH from two clinical sites in Tanzania, evaluated acceptability, feasibility, and preliminary effectiveness of a mental health intervention, Sauti ya Vijana (SYV; The Voice of Youth), was compared to the local standard-of-care (SOC) for improving ART adherence and virologic suppression. Enrolled YPLWH were 12-24years of age and responded to mental health and stigma questionnaires, self-reported adherence, objective adherence measures (ART concentration in hair), and HIV RNA at baseline and 6-months (post-intervention). Feasibility and acceptability were evaluated, and potential effectiveness was assessed by comparing outcomes between arms using mixed effects modeling.ResultsBetween June 2016 and July 2017, 128 YPLWH enrolled; 105 were randomized and 93 (55 in SYV) followed-up at 6-months and were thereby included in this analysis. Mean age was 18.1years; 51% were female; and 84% were HIV-infected perinatally. Attendance to intervention sessions was 86%; 6-month follow-up was 88%, and fidelity to the protocol approached 100%. Exploratory analyses of effectiveness demonstrated self-reported adherence improved by 7.3 percentage points (95% CI: 2.2, 12.3); and the pooled standard deviation for all ART concentration values increased by 0.17units (95% CI: -0.52, 0.85) in the SYV arm compared to SOC. Virologic suppression rates (HIV RNA