Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Glob Health Action. 2013 Jan 24;6:19248. doi: 10.3402/gha.v6i0.19248.
BACKGROUND: Ninety percent of the world's 2.1 million HIV-infected children live in sub-Saharan Africa, and 2.5% of South African children live with HIV. As HIV care and treatment programmes are scaled-up, a rise in loss to follow-up (LTFU) has been observed. OBJECTIVE: The aim of the study was to determine the rate of LTFU in children receiving antiretroviral treatment (ART) and to identify baseline characteristics associated with LTFU in the first year of treatment. We also explored the effect of patient characteristics at 12 months treatment on LTFU in the second year. METHODS: The study is an analysis of prospectively collected routine data of HIV-infected children at the Harriet Shezi Children's Clinic (HSCC) in Soweto, Johannesburg. Cox proportional hazards models were fitted to investigate associations between baseline characteristics and 12-month characteristics with LTFU in the first and second year on ART, respectively. RESULTS: The cumulative probability of LTFU at 12 months was 7.3% (95% CI 7.1-8.8). In the first 12 months on ART, independent predictors of LTFU were age <1 year at initiation, recent year of ART start, mother as a primary caregiver, and being underweight (WAZ ≤ -2). Among children still on treatment at 1 year from ART initiation, characteristics that predicted LTFU within the second year were recent year of ART start, mother as a primary caregiver, being underweight (WAZ ≤ -2), and low CD4 cell percentage. CONCLUSIONS: There are similarities between the known predictors of death and the predictors of LTFU in the first and second years of ART. Knowing the vital status of children is important to determine LTFU. Although HIV-positive children cared for by their mothers appear to be at greater risk of becoming LTFU, further research is needed to explore the challenges faced by mothers and other caregivers and their impact on long-term HIV care. There is also a need to investigate the effects of differential access to ART between mothers and children and its impact on ART outcomes in children.
背景：全世界 210 万感染艾滋病毒的儿童中，90%生活在撒哈拉以南非洲地区，南非有 2.5%的儿童携带艾滋病毒。随着艾滋病毒护理和治疗方案的扩大，失访率（LTFU）有所上升。 目的：本研究旨在确定接受抗逆转录病毒治疗（ART）的儿童的失访率，并确定治疗第一年与 LTFU 相关的基线特征。我们还探讨了治疗 12 个月时患者特征对第二年 LTFU 的影响。 方法：这项研究是对约翰内斯堡索韦托哈里特·谢齐儿童诊所（HSCC）前瞻性收集的 HIV 感染儿童常规数据进行的分析。使用 Cox 比例风险模型，分别调查了基线特征和 12 个月特征与 ART 第一年和第二年 LTFU 的相关性。 结果：在 12 个月时，LTFU 的累积概率为 7.3%（95%CI 7.1-8.8）。在开始接受 ART 的头 12 个月里，LTFU 的独立预测因素是开始治疗时年龄<1 岁、最近一年开始接受 ART、母亲是主要照顾者以及体重不足（WAZ≤-2）。在开始接受 ART 治疗 1 年后仍在接受治疗的儿童中，预测第二年 LTFU 的特征是最近一年开始接受 ART、母亲是主要照顾者、体重不足（WAZ≤-2）以及 CD4 细胞百分比低。 结论：在 ART 治疗的第一年和第二年，死亡的已知预测因素与 LTFU 的预测因素之间存在相似之处。了解儿童的生死状况对于确定 LTFU 很重要。尽管由母亲照顾的 HIV 阳性儿童似乎面临更大的失访风险，但需要进一步研究以探索母亲和其他照顾者所面临的挑战及其对儿童长期 HIV 护理的影响。还需要研究母亲和儿童之间接受抗逆转录病毒治疗的差异及其对儿童抗逆转录病毒治疗结果的影响。
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