Effectiveness of a peer-led adolescent mental health intervention on HIV virological suppression and mental health in Zimbabwe: protocol of a cluster-randomised trial
Effectiveness of a peer-led adolescent mental health intervention on HIV virological suppression and mental health in Zimbabwe: protocol of a cluster-randomised trial
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DOI：
10.1017/gmh.2020.14
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发表时间：
2020-01-01
影响因子：
3.9
通讯作者：
Willis, Nicola
中科院分区：
文献类型：
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作者：
Chinoda, Silindweyinkosi;Mutsinze, Abigail;Willis, Nicola
背景青少年艾滋病毒感染者（ALHIV）经历了心理健康障碍的沉重负担，这是坚持抗逆转录病毒治疗的一个障碍。在津巴布韦，经过培训和指导的艾滋病毒感染者同伴支持者（社区青少年治疗支持者）被发现可以改善艾滋病毒感染者的坚持、病毒抑制和心理社会健康。友谊长凳是非洲最大的综合心理健康方案。我们假设，结合CATS计划和友谊板凳将改善心理健康和病毒抑制ALHIV相比，单独的CATS程序。我们将在5个省的60家诊所进行1：1随机分组的整群随机对照试验。在控制部门诊所就诊的艾滋病毒/艾滋病患者将根据卫生部的指导方针获得标准的CATS支助和诊所支助。那些参加干预组诊所的人将接受友谊板凳解决问题的治疗，由受过训练的猫提供。有心理困扰迹象的参与者将被转介到诊所进行进一步评估和管理。主要结局是48周时HIV病毒学失败（>= 1000拷贝/ml）或死亡。次要结局包括青少年常见精神障碍症状的比例（定义为Shona症状问卷（SSQ-14）评分≥ 8）、抑郁症状的比例（定义为患者健康问卷（PHQ-9）评分≥ 11）、症状严重程度（SSQ-14和PHQ-9平均评分）和健康相关生活质量的EQ-5D评分。本试验评估了在ALHIV患者中，心理健康护理的同伴提供对心理健康和HIV病毒载量的有效性。如果有效，这种干预措施有可能扩大规模，以改善这些结果。
Background. Adolescents living with HIV (ALHIV) experience a high burden of mental health disorder which is a barrier to antiretroviral therapy adherence. In Zimbabwe, trained, mentored peer supporters living with HIV (Community Adolescent Treatment Supporters - CATS) have been found to improve adherence, viral suppression and psychosocial well-being among ALHIV. The Friendship Bench is the largest integrated mental health programme in Africa. We hypothesise that combining the CATS programme and Friendship Bench will improve mental health and virological suppression among ALHIV compared with the CATS programme alone.Methods. We will conduct a cluster-randomised controlled trial in 60 clinics randomised 1:1 in five provinces. ALHIV attending the control arm clinics will receive standard CATS support and clinic support following the Ministry of Health guidelines. Those attending the intervention arm clinics will receive Friendship Bench problem-solving therapy, delivered by trained CATS. Participants with the signs of psychological distress will be referred to the clinic for further assessment and management. The primary outcome is HIV virological failure (>= 1000 copies/ml) or death at 48 weeks. Secondary outcomes include the proportion of adolescents with common mental disorder symptoms (defined as Shona Symptom Questionnaire (SSQ-14) score >= 8), proportion with depression symptoms (defined as Patient Health Questionnaire (PHQ-9) score >= 11), symptom severity (mean SSQ-14 and PHQ-9 scores) and EQ-5D score for health-related quality of life.Conclusions. This trial evaluates the effectiveness of peer-delivery of mental health care on mental health and HIV viral load among ALHIV. If effective this intervention has the potential to be scaled-up to improve these outcomes.