Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
J Acquir Immune Defic Syndr. 2012 Feb 1;59(2):199-206. doi: 10.1097/QAI.0b013e31823b4448.
Kenya experienced a political and humanitarian crisis after presidential elections on December 27, 2007. We sought to describe both the immediate and long-term impact of this conflict for HIV-infected children in western Kenya.
We conducted a retrospective study of a cohort of these children for 3 periods: period 1, before the election (October 26, 2007, to December 25, 2007); period 2, immediately after the election (December 26, 2007, to April 15, 2008); and period 3, long-term postelection (April 16, 2008, to December 31, 2008). Two outcome variables of loss-to-follow-up (LTFU) were assessed: initial LTFU and complete LTFU. We assessed clinic adherence by evaluating the difference between actual visits and expected visits. Among children on antiretroviral therapy (ART), we assessed overall medication adherence and changes in medication adherence.
Two thousand five hundred forty-nine HIV-infected children <14 years were seen in period 1. Children on ART had less initial LTFU (3.0% compared with 5.1%, P < 0.01) and less complete LTFU (2.6% compared with 6.8%, P < 0.001) than children not on ART. For children not on ART, clinic adherence improved in period 3 compared with period 2. For children on ART with a more strict measure of clinic adherence, clinic adherence declined over time. Orphans had better clinic adherence than nonorphans. Among children on ART, there were few demographic differences when comparing medication adherence between time.
HIV-infected children are at risk for disruptions in clinic follow-up and medication adherence after a humanitarian crisis. Individual and contextual factors moderate the effects of these disruptions.
2007 年 12 月 27 日，肯尼亚在总统选举后爆发政治和人道主义危机。我们试图描述这场冲突对肯尼亚西部感染艾滋病毒的儿童产生的直接和长期影响。
我们对这组儿童进行了回顾性研究，分为三个时期：时期 1，选举前（2007 年 10 月 26 日至 12 月 25 日）；时期 2，选举后立即（2007 年 12 月 26 日至 2008 年 4 月 15 日）；时期 3，选举后长期（2008 年 4 月 16 日至 2008 年 12 月 31 日）。评估了两个失访（LTFU）的结果变量：初始 LTFU 和完全 LTFU。通过评估实际就诊次数与预期就诊次数的差异来评估就诊依从性。在接受抗逆转录病毒治疗（ART）的儿童中，我们评估了整体药物依从性和药物依从性的变化。
时期 1 共观察到 2549 名<14 岁的 HIV 感染儿童。接受 ART 的儿童初始 LTFU 率（3.0%，比 5.1%，P<0.01）和完全 LTFU 率（2.6%，比 6.8%，P<0.001）均低于未接受 ART 的儿童。对于未接受 ART 的儿童，与时期 2 相比，时期 3 的就诊依从性有所提高。对于就诊依从性要求更严格的接受 ART 的儿童，随着时间的推移，就诊依从性下降。孤儿的就诊依从性好于非孤儿。在接受 ART 的儿童中，药物依从性在时间上的差异与人口统计学差异较小。
在人道主义危机后，艾滋病毒感染儿童面临着就诊中断和药物依从性下降的风险。个人和环境因素会影响这些中断的影响。
