PDF(Pubmed)
Abstract：
BACKGROUND: Combination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples\' sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16-29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people.
METHODS: The process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed.
RESULTS: The intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people\'s sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people.
CONCLUSIONS: The results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them.
METHODS: The process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed.
RESULTS: The intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people\'s sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people.
CONCLUSIONS: The results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them.
摘要：
背景：联合预防干预措施，当与基于社区的支持相结合时，已被证明对青少年和年轻人的性健康和生殖健康特别有益。在2020年至2022年之间，南非农村地区的非洲健康研究所在16-29岁的年轻人（IsisekeloSempilo）中进行了2×2随机析因试验，以评估艾滋病毒与性健康和生殖健康（HIV/SRH）是否有或没有同伴支持将优化艾滋病毒预防和护理的提供。使用混合方法，我们进行了一项过程评估,以深入了解和描述针对青少年和年轻人的基于社区的同伴主导的HIV护理和预防干预的实施情况.
方法：根据医学研究理事会指南使用定量和定性方法进行过程评估。使用自我完成的调查以及临床和计划数据来量化干预措施每个组成部分的吸收，并了解干预措施的保真度和覆盖范围。深入的个人访谈用于了解干预经验。总结了每个试验组的基线社会人口统计学因素，并计算了接受并积极参与干预各个组成部分的参与者以及成功与护理相关的参与者的比例。定性数据进行了主题分析。
结果：该干预措施是可行的，年轻人和干预实施团队可以接受。特别是,干预措施的STI检测和SRH组件很受欢迎.对等支持实施的主要挑战是由于保真度，主要是因为COVID-19大流行。研究发现，将家庭支持纳入年轻人性健康的干预措施非常重要。此外，研究发现，心理和社会支持是年轻人艾滋病毒预防一揽子计划的重要组成部分。
结论：结果表明，将SRH服务与HIV整合在一起的以同伴为主导的社区护理是分散健康和社会护理的通用模式。家庭可能是一个针对限制性性别和性规范的平台，不仅挑战年轻人中与性别有关的态度和行为，而且挑战他们周围的性别结构。
方法：根据医学研究理事会指南使用定量和定性方法进行过程评估。使用自我完成的调查以及临床和计划数据来量化干预措施每个组成部分的吸收，并了解干预措施的保真度和覆盖范围。深入的个人访谈用于了解干预经验。总结了每个试验组的基线社会人口统计学因素，并计算了接受并积极参与干预各个组成部分的参与者以及成功与护理相关的参与者的比例。定性数据进行了主题分析。
结果：该干预措施是可行的，年轻人和干预实施团队可以接受。特别是,干预措施的STI检测和SRH组件很受欢迎.对等支持实施的主要挑战是由于保真度，主要是因为COVID-19大流行。研究发现，将家庭支持纳入年轻人性健康的干预措施非常重要。此外，研究发现，心理和社会支持是年轻人艾滋病毒预防一揽子计划的重要组成部分。
结论：结果表明，将SRH服务与HIV整合在一起的以同伴为主导的社区护理是分散健康和社会护理的通用模式。家庭可能是一个针对限制性性别和性规范的平台，不仅挑战年轻人中与性别有关的态度和行为，而且挑战他们周围的性别结构。
