常规住院患者人类免疫缺陷病毒检测系统增加了撒哈拉以南非洲地区儿科人类免疫缺陷病毒护理的可及性。

Routine inpatient human immunodeficiency virus testing system increases access to pediatric human immunodeficiency virus care in sub-Saharan Africa.

机构信息

Baylor International Pediatric AIDS Initiative, Baylor College of Medicine, Lilongwe, Malawi.

出版信息

Pediatr Infect Dis J. 2011 May;30(5):e75-81. doi: 10.1097/INF.0b013e3182103f8a.

DOI:10.1097/INF.0b013e3182103f8a

PMID:21297520

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4157210/

Abstract

BACKGROUND

Routine Human Immunodeficiency Virus (HIV) testing, called provider-initiated opt-out HIV testing and counseling (PITC), is recommended in African countries with high HIV prevalence. However, it is unknown whether PITC increases access to pediatric HIV care. In 2008, the Baylor International Pediatric AIDS Initiative implemented PITC (BIPAI-PITC) at a Malawian hospital. We sought to evaluate the influence of BIPAI-PITC, compared with nonroutine HIV testing (NRT), on pediatric HIV care access.

METHODS

Retrospective data from 7077 pediatric inpatients were collected during sequential 4-month periods of NRT and BIPAI-PITC. In-hospital and 1-year outcomes for 337 HIV-infected and HIV-exposed uninfected inpatients not previously enrolled in HIV care were analyzed to assess the clinical influence of each testing strategy.

RESULTS

During BIPAI-PITC, a greater proportion of all hospitalized children received HIV testing (81.0% vs. 33.3%, P < 0.001), accessed inpatient HIV-trained care (7.5% vs. 2.4%, P < 0.001), enrolled into an outpatient HIV clinic after discharge (3.2% vs. 1.3%, P < 0.001), and initiated antiretroviral therapy (ART) after hospitalization (1.1% vs. 0.6%, P = 0.010) compared with NRT. Additionally, BIPAI-PITC increased the proportion of hospitalized HIV-infected and HIV-exposed uninfected children receiving DNA polymerase chain reaction testing (73.5% vs. 35.2%, P < 0.001), but did not improve outpatient enrollment or ART initiation of identified HIV-infected patients.

CONCLUSIONS

BIPAI-PITC increases access to inpatient and outpatient pediatric HIV care for hospitalized children, including DNA polymerase chain reaction testing and ART. Broader implementation of BIPAI-PITC or similar approaches, along with more pediatric HIV-trained clinicians and improved defaulter-tracking methods, would improve pediatric HIV service utilization globally.

摘要

背景

在艾滋病毒（HIV）流行率较高的非洲国家，建议进行常规 HIV 检测，即医务人员主动提供的 HIV 检测和咨询（PITC）。然而，目前尚不清楚 PITC 是否会增加获得儿科 HIV 护理的机会。2008 年，贝勒国际儿科艾滋病倡议（Baylor International Pediatric AIDS Initiative）在马拉维的一家医院实施了 PITC（BIPAI-PITC）。我们试图评估与非常规 HIV 检测（NRT）相比，BIPAI-PITC 对儿科 HIV 护理机会的影响。

方法

在 NRT 和 BIPAI-PITC 连续 4 个月期间，收集了 7077 名儿科住院患者的回顾性数据。分析了 337 名未参加过 HIV 护理的 HIV 感染和 HIV 暴露的未感染住院患者的院内和 1 年结局，以评估两种检测策略的临床影响。

结果

在 BIPAI-PITC 期间，更多比例的住院儿童接受了 HIV 检测（81.0%比 33.3%，P<0.001），获得了接受 HIV 培训的住院护理（7.5%比 2.4%，P<0.001），出院后到门诊 HIV 诊所就诊（3.2%比 1.3%，P<0.001），并在住院后开始接受抗逆转录病毒治疗（ART）（1.1%比 0.6%，P=0.010），与 NRT 相比。此外，BIPAI-PITC 增加了接受 DNA 聚合酶链反应检测的住院 HIV 感染和 HIV 暴露的未感染儿童的比例（73.5%比 35.2%，P<0.001），但并未改善已确定的 HIV 感染患者的门诊就诊率或 ART 启动率。