Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
J Acquir Immune Defic Syndr. 2011 Jul 1;57(3):e40-6. doi: 10.1097/QAI.0b013e3182167f0d.
The objective of this study was to identify the vital status and reasons for children becoming loss to follow-up (LTFU) from a large program in western Kenya.
This was a prospective evaluation of a random sample of 30% of HIV-exposed and HIV-positive children LTFU from either an urban or rural HIV Academic Model Providing Access to Healthcare clinic. LTFU is defined as absence from clinic for >6 months if on combination antiretroviral therapy and > 12 months if not. Experienced community health workers were engaged to locate them.
There were 97 children sampled (78 urban, 19 rural). Of these, 82% were located (78% urban, 100% rural). Among the HIV positive, 16% of the children were deceased, and 16% had not returned to clinic because of disclosure issues/discrimination in the family or community. Among the HIV exposed, 30% never returned to care because their guardians either had not disclosed their own HIV status or were afraid of family/community stigma related to their HIV status or that of the child. Among children whose HIV status was unknown, 29% of those found had actually died, and disclosure/discrimination accounted for 14% of the reasons for becoming LTFU. Other reasons included believing the child was healed by faith or through the use of traditional medicine (7%), transport costs (6%), and transferring care to other programs or clinics (8%).
After locating >80% of the children in our sample, we identified that mortality and disclosure issues including fear of family or community discrimination were the most important reasons why these children became LTFU.
本研究旨在确定肯尼亚西部一个大型项目中儿童失访（LTFU）的生存状况和原因。
这是对来自城市或农村 HIV 学术模型提供医疗保健诊所的随机抽取的 30％HIV 暴露和 HIV 阳性儿童失访者的前瞻性评估。失访定义为接受联合抗逆转录病毒治疗时超过 6 个月未就诊，未接受治疗时超过 12 个月未就诊。经验丰富的社区卫生工作者被招募来寻找这些儿童。
共抽取了 97 名儿童（78 名城市，19 名农村）。其中 82％的儿童被找到（城市 78％，农村 100％）。在 HIV 阳性儿童中，16％的儿童死亡，16％的儿童因家庭或社区的披露问题/歧视而未返回诊所。在 HIV 暴露儿童中，30％的儿童从未返回护理，因为他们的监护人未透露自己的 HIV 状况，或者害怕与自己的 HIV 状况或儿童的 HIV 状况有关的家庭/社区耻辱。在 HIV 状况未知的儿童中，发现 29％的儿童实际上已经死亡，披露/歧视占失访原因的 14％。其他原因包括相信孩子是通过信仰或使用传统医学治愈的（7％），运输成本（6％），以及将护理转移到其他项目或诊所（8％）。
在找到我们样本中 80％以上的儿童后，我们发现死亡率和披露问题，包括对家庭或社区歧视的恐惧，是这些儿童失访的最重要原因。
