Lighthouse Trust at Kamuzu Central Hospital, PO Box 106, Lilongwe, Malawi.
BMC Pediatr. 2009 Dec 18;9:80. doi: 10.1186/1471-2431-9-80.
The HIV prevalence in Malawi is 12% and Kamuzu Central Hospital (KCH), in the capital Lilongwe, is the main provider of adult and paediatric HIV services in the central region. The Lighthouse at KCH offers opt-in HIV testing and counselling (HTC) for adults and children. In June 2004, Lighthouse was the first clinic to provide free antiretroviral treatment (ART) in the public sector, but few children accessed the services. In response, provider-initiated HIV testing and counselling (PITC) and an ART clinic were introduced at the paediatric department at KCH in Quarter 4 (Q4) 2004.
We analysed prospectively collected, aggregated data of quarterly reports from Q1 2003 to Q4 2006 from HTC centre registers, ART registers and clinic registrations at the ART clinics of both Lighthouse and the paediatric department. By comparing data of both facilities before (Q1 2003 to Q3 2004), and after the introduction of the services at the paediatric department (Q4 2004 to Q4 2006), we assessed the effect of this intervention on the uptake of HIV services for children at KCH.
Overall, 3971 children were tested for HIV, 2428 HIV-infected children were registered for care and 1218 started ART. Between the two periods, the median (IQR) number of children being tested, registered and starting ART per quarter rose from 101 (53-109) to 358 (318-440), 56 (50-82) to 226 (192-234) and 18 (8-23) to 139 (115-150), respectively. The median proportion of tested clients per quarter that were children rose from 3.8% (2.7-4.3) to 9.6% (8.8 to 10.0) (p = 0.0009) and the proportion of ART starters that were children rose from 6.9% (4.9-9.3) to 21.1% (19.2-24.2) (p = 0.0036). The proportion of registered children and adults starting ART each quarter increased similarly, from 26% to 53%, and 20% to 52%, respectively.
Implementation of PITC and integration of ART services within the paediatric ward are likely to be the main reasons for improved access to HTC and ART for children at KCH, and can be recommended to other hospitals with paediatric inpatients in resource limited settings with high HIV prevalence.
马拉维的艾滋病毒感染率为 12%，卡姆祖中央医院（KCH）是首都利隆圭为中部地区提供成人和儿科艾滋病毒服务的主要提供者。KCH 的灯塔为成人和儿童提供选择性艾滋病毒检测和咨询（HTC）。2004 年 6 月，灯塔是公共部门第一个提供免费抗逆转录病毒治疗（ART）的诊所，但很少有儿童获得该服务。作为回应，在 2004 年第四季度（Q4），在 KCH 儿科部门引入了提供者启动的艾滋病毒检测和咨询（PITC）和 ART 诊所。
我们分析了 2003 年第一季度至 2006 年第四季度从 HTC 中心登记册、ART 登记册和灯塔和儿科部门的 ART 诊所登记册中前瞻性收集的季度报告汇总数据。通过比较儿科部门引入服务前后（2003 年第一季度至 2004 年第三季度）的数据，我们评估了这一干预措施对 KCH 儿童接受艾滋病毒服务的影响。
总体而言，有 3971 名儿童接受了艾滋病毒检测，2428 名艾滋病毒感染儿童接受了护理登记，1218 名儿童开始接受 ART。在这两个时期，每季度接受检测、登记和开始 ART 的儿童中位数（IQR）从 101（53-109）增加到 358（318-440），56（50-82）增加到 226（192-234），18（8-23）增加到 139（115-150）。每季度接受检测的客户中儿童的中位数比例从 3.8%（2.7-4.3）上升到 9.6%（8.8 至 10.0）（p = 0.0009），开始接受 ART 的儿童比例从 6.9%（4.9-9.3）上升到 21.1%（19.2-24.2）（p = 0.0036）。每季度登记的儿童和成人开始接受 ART 的比例也分别从 26%增加到 53%和 20%增加到 52%。
实施 PITC 和将 ART 服务纳入儿科病房可能是改善 KCH 儿童获得 HTC 和 ART 的主要原因，可向资源有限、艾滋病毒流行率高的其他有儿科住院病人的医院推荐。
