van Dijk Janneke H, Sutcliffe Catherine G, Munsanje Bornface, Hamangaba Francis, Thuma Philip E, Moss William J
Medical/Malaria Institute at Macha, Macha Hospital, Choma, Zambia.
BMC Infect Dis. 2009 Oct 16;9:169. doi: 10.1186/1471-2334-9-169.
Successful antiretroviral treatment programs in rural sub-Saharan Africa may face different challenges than programs in urban areas. The objective of this study was to identify patient characteristics, barriers to care, and treatment responses of HIV-infected children seeking care in rural Zambia.
Cross-sectional analysis of HIV-infected children seeking care at Macha Hospital in rural southern Zambia. Information was collected from caretakers and medical records.
192 HIV-infected children were enrolled from September 2007 through September 2008, 28% of whom were receiving antiretroviral therapy (ART) at enrollment. The median age was 3.3 years for children not receiving ART (IQR 1.8, 6.7) and 4.5 years for children receiving ART (IQR 2.7, 8.6). 91% travelled more than one hour to the clinic and 26% travelled more than 5 hours. Most participants (73%) reported difficulties accessing the clinic, including insufficient money (60%), lack of transportation (54%) and roads in poor condition (32%). The 54 children who were receiving ART at study enrollment had been on ART a median of 8.6 months (IQR: 2.7, 19.5). The median percentage of CD4+ T cells was 12.4 (IQR: 9.2, 18.6) at the start of ART, and increased to 28.6 (IQR: 23.5, 36.1) at the initial study visit. However, the proportion of children who were underweight decreased only slightly, from 70% at initiation of ART to 61% at the initial study visit.
HIV-infected children in rural southern Zambia have long travel times to access care and may have poorer weight gain on ART than children in urban areas. Despite these barriers, these children had a substantial rise in CD4+ T cell counts in the first year of ART although longer follow-up may indicate these gains are not sustained.
撒哈拉以南非洲农村地区成功的抗逆转录病毒治疗项目可能面临与城市地区项目不同的挑战。本研究的目的是确定在赞比亚农村寻求治疗的艾滋病毒感染儿童的患者特征、护理障碍和治疗反应。
对在赞比亚南部农村的马查医院寻求治疗的艾滋病毒感染儿童进行横断面分析。从看护者和医疗记录中收集信息。
2007年9月至2008年9月，共纳入192名艾滋病毒感染儿童，其中28%在入组时接受抗逆转录病毒治疗（ART）。未接受ART的儿童中位年龄为3.3岁（四分位间距1.8，6.7），接受ART的儿童中位年龄为4.5岁（四分位间距2.7，8.6）。91%的儿童前往诊所的时间超过1小时，26%的儿童超过5小时。大多数参与者（73%）报告就医困难，包括资金不足（60%）、缺乏交通工具（54%）和路况不佳（32%）。在研究入组时接受ART的54名儿童接受ART的中位时间为8.6个月（四分位间距：2.7，19.5）。ART开始时CD4 + T细胞的中位百分比为12.4（四分位间距：9.2，18.6），在初次研究访视时增至28.6（四分位间距：23.5，36.1）。然而，体重不足儿童的比例仅略有下降，从ART开始时的70%降至初次研究访视时的61%。
赞比亚南部农村地区的艾滋病毒感染儿童就医路途时间长，与城市地区儿童相比，接受ART治疗时体重增加可能较差。尽管存在这些障碍，但这些儿童在ART治疗的第一年CD4 + T细胞计数大幅上升，不过更长时间的随访可能表明这些增加无法持续。
