INSERM, ISPED, Centre INSERM U-897-Epidemiologie-Biostatistique, Bordeaux, France.
PLoS One. 2012;7(3):e33690. doi: 10.1371/journal.pone.0033690. Epub 2012 Mar 21.
We assessed the effect of HIV status disclosure on retention in care from initiation of antiretroviral therapy (ART) among HIV-infected children aged 10 years or more in Cote d'Ivoire, Mali and Sénégal.
Multi-centre cohort study within five paediatric clinics participating in the IeDEA West Africa collaboration. HIV-infected patients were included in this study if they met the following inclusion criteria: aged 10-21 years while on ART; having initiated ART ≥ 200 days before the closure date of the clinic database; followed ≥ 15 days from ART initiation in clinics with ≥ 10 adolescents enrolled. Routine follow-up data were merged with those collected through a standardized ad hoc questionnaire on awareness of HIV status. Probability of retention (no death or loss-to-follow-up) was estimated with Kaplan-Meier method. Cox proportional hazard model with date of ART initiation as origin and a delayed entry at date of 10th birthday was used to identify factors associated with death or loss-to-follow-up.
650 adolescents were available for this analysis. Characteristics at ART initiation were: median age of 10.4 years; median CD4 count of 224 cells/mm³ (47% with severe immunosuppression), 48% CDC stage C/WHO stage 3/4. The median follow-up on ART after the age of 10 was 23.3 months; 187 adolescents (28.8%) knew their HIV status. The overall probability of retention at 36 months after ART initiation was 74.6% (95% confidence interval [CI]: 70.5-79.0) and was higher for those disclosed compared to those not: adjusted hazard ratio for the risk of being death or loss-to-follow-up = 0.23 (95% CI: 0.13-0.39).
About 2/3 of HIV-infected adolescents on ART were not aware of their HIV status in these ART clinics in West Africa but disclosed HIV status improved retention in care. The disclosure process should be thus systematically encouraged and organized in adolescent populations.
我们评估了在科特迪瓦、马里和塞内加尔，10 岁或以上感染 HIV 的儿童从开始接受抗逆转录病毒治疗（ART）到接受护理的保留率中，HIV 状态披露的影响。
在参与 IeDEA 西非合作的五家儿科诊所内进行的多中心队列研究。如果符合以下纳入标准，将 HIV 感染患者纳入本研究：年龄在 10-21 岁之间，正在接受 ART；在诊所数据库关闭日期前≥200 天开始接受 ART；在至少有 10 名青少年入组的诊所中，从开始接受 ART 起至少随访 15 天。常规随访数据与通过专门的标准化调查问卷收集的有关 HIV 状态意识的数据合并。使用 Kaplan-Meier 方法估计保留率（无死亡或失访）。使用 Cox 比例风险模型，以 ART 开始日期为原点，以 10 岁生日为延迟进入日期，确定与死亡或失访相关的因素。
650 名青少年可用于本分析。ART 开始时的特征为：中位年龄为 10.4 岁；中位 CD4 计数为 224 个细胞/mm³（47% 严重免疫抑制），48% 的 CDC 分期 C/WHO 分期 3/4。10 岁后接受 ART 的中位随访时间为 23.3 个月；187 名（28.8%）青少年知晓自己的 HIV 状态。ART 开始后 36 个月的总体保留率为 74.6%（95%置信区间 [CI]：70.5-79.0），与未披露相比，披露 HIV 状态的保留率更高：死亡或失访风险的调整风险比为 0.23（95% CI：0.13-0.39）。
在这些西非的 ART 诊所中，大约 2/3 的接受 ART 的 HIV 感染青少年不知道自己的 HIV 状态，但披露 HIV 状态可提高护理保留率。因此，应系统地鼓励和组织青少年人群进行披露过程。
