Purpose

Psychosocial interventions have the potential to support adolescents and young people living with HIV (AYPLHIV) to achieve better HIV outcomes. However, more evidence is needed to understand which interventions are most effective, and the mechanisms driving how they work in practice.

Methods

We used realist methodologies to generate statements based on evidence from intervention studies and linked evidence included in a systematic review of psychosocial interventions for AYPLHIV. Key data were extracted from available sources to generate cases, including context-mechanism-outcome pathways. Higher level themes were refined iteratively to create a mid-range theory of how these interventions may work.

Results

From 26 resulting cases, 8 statements were crafted, grouped into 3 overarching categories, to describe how these interventions worked. Interventions were overall found to set off mechanisms to improve adherence when (1) responding to individual-level factors to support AYPLHIV (via incorporating agency and empowerment, personalized and/or contextualized approaches, and self-care skills); (2) tailoring delivery strategies to address specific needs (via diverse strategies, longer duration, and digital delivery); and (3) providing supportive resources (via peer and broader support, and structural support and integration into existing services).

Discussion

A collection of diverse mechanisms may individually or collectively drive improved outcomes for AYPLHIV engaged in psychosocial interventions. Recommendations for integrating our findings into practice are discussed.

中文翻译：

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对感染艾滋病毒的青少年和年轻人进行社会心理干预如何提高依从性和病毒载量？现实主义评论

目的

社会心理干预有可能支持感染艾滋病毒的青少年和年轻人 (AYPLHIV) 取得更好的艾滋病治疗结果。然而，需要更多的证据来了解哪些干预措施最有效，以及推动它们在实践中如何发挥作用的机制。

方法

我们使用现实主义方法，根据干预研究的证据和对 AYPLHIV 的社会心理干预的系统评价中包含的相关证据生成陈述。从可用资源中提取关键数据以生成案例，包括背景-机制-结果路径。更高层次的主题被反复提炼，以创建一个关于这些干预措施如何运作的中档理论。

结果

从 26 个最终案例中，拟定了 8 个陈述，分为 3 个总体类别，以描述这些干预措施的工作原理。总体上发现干预措施在以下情况下启动了提高依从性的机制：（1）响应个人层面的因素以支持 AYPLHIV（通过结合机构和授权、个性化和/或情境化方法以及自我护理技能）；(2) 定制交付策略以满足特定需求（通过多样化策略、更长的持续时间和数字交付）；(3) 提供支持性资源（通过同行和更广泛的支持，以及结构性支持和与现有服务的整合）。

讨论

一系列不同的机制可能单独或共同推动 AYPLHIV 参与社会心理干预的结果得到改善。讨论了将我们的发现融入实践的建议。