The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial.
The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial.
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DOI：
10.1371/journal.pmed.1004203
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发表时间：
2023-04
期刊：
影响因子：
15.8
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中科院分区：
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撒哈拉以南非洲15至24岁的青少年和年轻人（AYP）人口不断增长，在许多情况下面临着艾滋病毒的沉重负担。本区域少女意外怀孕的比例仍然很高。尽管如此，青年计划的性健康和生殖健康服务需求仍然得不到充分满足。我们进行了一项群集随机试验（CRT），以评估以社区为基础的、同伴主导的性健康和生殖健康服务提供对艾滋病毒状况和其他性健康和生殖健康结果（包括满足避孕药具需求）的影响。Yathu Yathu是一项于2019年至2021年在赞比亚卢萨卡的2个城市社区进行的集群随机试验（CRT）。这些社区被分为20个区（每个区约2 350名青年志愿者），随机分配给Yathu Yathu干预或控制部门，在每个干预区建立了一个社区中心，配备同伴支助工作人员，提供性健康和生殖健康服务。2019年，在所有地区进行了人口普查;所有同意的15至24岁的AYP都获得了Yathu Yathu卡，允许他们在中心和卫生设施（干预组）或仅在卫生设施（对照组）获得性健康和生殖健康服务。积分可以兑换奖励，从而激励两个部门使用性健康和生殖健康服务。我们在2021年进行了一项横断面调查，以评估Yathu Yathu对主要结局的影响：艾滋病毒状况的知识（过去12个月内自我报告感染艾滋病毒或进行艾滋病毒检测）和次要结局，包括过去12个月内使用暴露前预防（PrEP），目前使用抗逆转录病毒治疗（ART）和满足避孕服务需求。样本按性别和年龄组分层，我们使用推荐用于CRT的两阶段过程分析聚类水平的数据，每组<15个聚类。共有1，989名AYP同意参与调查（50%为男性）;各组的同意率相似（每组63%同意）。各地区对艾滋病毒状况的了解在干预区为63.6%至81.2%，在对照区为35.4%至63.0%。经年龄、性别和社区调整后，干预组的艾滋病毒状况知识高于对照组（分别为73.3%和48.4%，调整后的患病率（PR）1.53 95%CI 1.36，1.72; p < 0.001）。根据年龄和性别，结果相似。没有证据表明对任何次要结局有影响，包括目前使用ART和满足避孕需求。两组均未报告不良事件。我们试验的一个关键限制是，随机选择参与终点调查的AYP中约有35%无法达到。与对照组相比，提供以社区为基础、由同伴领导的性健康和生殖健康服务增加了青年志愿者（包括男性和女性）对艾滋病毒状况的了解，推广非常有效的Yathu Yathu战略有可能为增加青年人获得艾滋病毒预防和护理服务的机会做出重大贡献。然而，需要进行更多的实施研究，以了解如何在艾滋病毒检测之外，更好地接受更广泛的性健康和生殖健康服务。ISRCTN 75609016，clinicaltrials.gov编号NCT 04060420 Bernadette Hensen及其同事调查了赞比亚青少年和年轻人以社区为基础提供性健康和生殖健康服务是否增加了对艾滋病毒状况的了解。青少年和年轻人获得性健康和生殖健康服务的机会有限;需要有与年轻人共同制定的战略的严格证据，以改善获得这些服务的机会。这项试验的目的是调查在赞比亚卢萨卡由同龄人提供以社区为基础的性健康和生殖健康服务是否会增加15至24岁的青年志愿者对艾滋病毒状况的了解。通过社区空间（称为中心），同伴支助工作者、一名护士和主管每天向15至24岁的青年志愿者提供一系列性健康和生殖健康服务，包括艾滋病毒检测、全面的性教育和避孕药具。通过枢纽提供服务还辅以奖励措施，即为获得的服务收集积分，并能够使用这些积分“购买”肥皂、牙刷和牙膏等奖励。大约24个月后，我们比较了随机选择的15至24岁的AYP（N = 1，989）之间的艾滋病毒状态知识（定义为自我报告的艾滋病毒阳性状态或在过去12个月内进行艾滋病毒检测），这些AYP居住在接受Yathu Yathu干预的地区和没有接受干预的地区。我们发现，与非干预地区（48.4%）相比，干预地区（73.3%）对状况的了解要高得多，但在接受其他性健康和生殖健康服务方面没有差异，例如与预防艾滋病毒的PrEP挂钩。这些研究结果表明，提供一系列性健康和生殖健康服务并辅之以激励措施的社区中心可以增加对艾滋病毒状况的了解。需要进行更多的研究，以改善其他服务的提供，包括与预防和护理服务的联系，以及获得避孕服务的机会。
The growing population of adolescents and young people (AYP) aged 15 to 24 in sub-Saharan Africa face a high burden of HIV in many settings. Unintended pregnancies among adolescent girls in the region remain high. Nonetheless, the sexual and reproductive health (SRH) service needs of AYP have remained underserved. We conducted a cluster-randomised trial (CRT) to estimate the impact of community-based, peer-led SRH service provision on knowledge of HIV status and other SRH outcomes, including met need for contraceptives. Yathu Yathu was a cluster-randomised trial (CRT) conducted from 2019 to 2021 in 2 urban communities in Lusaka, Zambia. The communities were divided into 20 zones (approximately 2,350 AYP/zone) that were randomly allocated to the Yathu Yathu intervention or control arm. In each intervention zone, a community-based hub, staffed by peer support workers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15 to 24 were given a Yathu Yathu card, which allowed them to accrue points for accessing SRH services at the hub and health facility (intervention arm) or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive to use SRH services in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome: knowledge of HIV status (self-reporting living with HIV or HIV testing in the last 12 months) and secondary outcomes, including use of pre-exposure prophylaxis (PrEP) in the last 12 months, current use of antiretroviral therapy (ART), and met need for contraceptive services. The sampling was stratified on sex and age group, and we analysed data at cluster-level using a two-stage process recommended for CRTs with <15 clusters/arm. A total of 1,989 AYP consented to participate in the survey (50% male); consent was similar across arms (63% consent/arm). Across zones, knowledge of HIV status ranged from 63.6% to 81.2% in intervention zones and 35.4% to 63.0% in control zones. Adjusting for age, sex, and community, knowledge of HIV status was higher in the intervention arm compared to control (73.3% versus 48.4%, respectively, adjusted prevalence ratio (PR) 1.53 95% CI 1.36, 1.72; p < 0.001). By age and sex, results were similar. There was no evidence for impact on any secondary outcomes, including current use of ART and met need for contraceptives. There were no adverse events reported in either arm. A key limitation of our trial is that approximately 35% of the AYP randomly selected for participation in the endline survey could not be reached. Delivering community-based, peer-led SRH services increased knowledge of HIV status among AYP, both males and females, compared with the control arm. Scaling up the highly effective Yathu Yathu strategy has the potential to make a substantial contribution to increasing access to HIV prevention and care services for young people. However, additional implementation research is needed to understand how to improve uptake of broader SRH services, beyond uptake of HIV testing. ISRCTN75609016, clinicaltrials.gov number NCT04060420 Bernadette Hensen and colleagues investigate whether community-based delivery of sexual and reproductive health services by peers increased knowledge of HIV status among adolescents and young people in Zambia. Adolescents and young people (AYP) have limited access to sexual and reproductive health (SRH) services; rigorous evidence of strategies, co-developed with young people, that improve access to these services is needed. This trial was done to investigate whether community-based delivery of SRH services by peers would increase knowledge of HIV status among AYP aged 15 to 24 in Lusaka, Zambia. Through spaces in the community (called hubs), peer support workers, a nurse and supervisor, delivered a range of SRH services, including HIV testing, comprehensive sexuality education, and contraceptives, daily to AYP aged 15 to 24. Service delivery through hubs was complemented by incentives, namely the collection of points for services accessed and the ability to use these points to “buy” rewards, such as soap, toothbrush, and toothpaste. After approximately 24 months, we compared knowledge of HIV status (defined as either self-reporting knowing ones HIV–positive status or having HIV tested in the previous 12 months) between random selections of AYP aged 15 to 24 (N = 1,989) living in areas that received the Yathu Yathu intervention and in areas that did not receive the intervention. We found that knowledge of status was considerably higher in the intervention areas (73.3%) as compared to the non-intervention areas (48.4%), but that there was no difference in uptake of other SRH services, such as linkage to PrEP for the prevention of HIV. These findings show that community-based hubs that deliver a range of SRH services and are complemented by incentives can increase knowledge of HIV status. Additional research is needed to improve delivery of other services, including linkage to prevention and care services, and access to contraceptive services.
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