HIV予防の選択肢と精神保健サービスの提供を組み合わせる 少女と若い女性 (CHOMA):南アフリカにおけるハイブリッド有効性実施ランダム化試験の結果
Jennifer Velloza1,2, Nomhle Ndimande-Khoza3, Lisa Mills3
1Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA.
Journal of the International AIDS Society
|September 4, 2025
まとめ
Youth Friendship Bench SAの介入は,未成年少女と若い女性 (AGYW) の暴露前予防療法 (PrEP) の遵守を第4週に改善したが,第12週には改善しなかった. 一般的な精神障害の症状は全体的に減少し,統合された精神衛生とPrEPのサポートが不可欠であることを示唆しています.
科学分野:
- 公衆衛生
- 精神 的 な 健康
- HIV 予防
背景:
- HIVの危険にさらされている少女と若い女性は,しばしば一般的な精神障害 (CMD) を経験し,暴露前の予防療法 (PrEP) の遵守に影響します.
- CHOMAのハイブリッド試験では,CMDに対処し,南アフリカのAGYWのPrEP遵守を改善するための"Youth Friendship Bench SA"の介入を評価しました.
研究 の 目的:
- 適応された"Youth Friendship Bench SA"の精神衛生介入の有効性を評価し,PrEPの遵守とCMDの症状の軽減を AGYWで評価する.
- メンタルヘルスの支援とPrEPの提供を統合する実施の可行性,受容性,適宜性を評価する.
主な方法:
- ハイブリッド効果導入試験では,ヨハネスブルグでCMD症状 (SRQ-20≥7) を有する116人の高齢女性 (18~25歳) が参加した.
- 参加者は"Youth Friendship Bench SA"介入 (問題解決セッション) または標準的なCMDサービスにランダムに割り当てられました.
- コプライマリーアウトカムには,PREPの遵守 (尿中テノフォビル測定) と,第4週および第12週におけるCMD症状の減少 (SRQ-20< 7) が含まれていた.
主要な成果:
- 介入グループでは,第4週にPREPの遵守が改善されました (80. 6% vs 61. 0%),しかし,この効果は第12週に持続しませんでした (p=0. 44).
- CMDの症状は,第4週 (54. 5%) から第12週 (35. 0%) まで全体的に減少し,介入と標準治療の間で有意な差異はありませんでした.
- 介入の許容度,適度,実行可能性のスコアは高かった (中位はそれぞれ3. 50,3. 75,3. 25).
結論:
- "Youth Friendship Bench SA"の介入は,AGYWの短期間のPrEP遵守を改善する可能性があるが,持続性を高めるためにさらなる研究が必要である.
- 両方の腕で観察されたCMD症状の減少は,効果的な精神保健支援の必要性を強調しているが,統合されたアプローチは最適化が必要である.
- AGYWの間で統合されたサービスの提供を改善するために,メンタルヘルスとPrEPのサポート介入が必要であることを示唆しています.
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