Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
J Acquir Immune Defic Syndr. 2013 Jun 1;63(2):e49-55. doi: 10.1097/QAI.0b013e31828e1e2c.
Nonadherence to clinic appointments is associated with poor outcomes in HIV-infected adults. We describe the effect of cumulative clinic adherence (CCA) to clinic appointments on mortality and loss to follow-up (LTFU) among HIV-infected children in Kenya.
We analyzed retrospective clinical data from HIV-infected children in the United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership in Kenya between 2001 and 2009. We defined CCA as the proportion of days adherent to clinic visits after enrollment. We examined the effects of CCA on both death and LTFU, controlling for demographic and clinical factors at enrollment and over time. Cox proportional hazards models with time-varying coefficients were used to calculate adjusted hazard ratios (AHR) associated with each 10% increase in CCA on mortality and LTFU.
Among 3255 HIV-infected children, 1668 (51.2%) were male, median enrollment age of 5.2 years (interquartile range: 3.6-7.4). Of 2393 children with CD4 within 3 months after enrollment, 1125 (47.0%) were severely immune suppressed, 567 became LTFU, and 88 died. Children with higher CCA had a higher risk of both mortality and LTFU at 3 and 6 months. Higher CCA became protective at 24 months for mortality, AHR at 24 months: 0.7 (95% confidence interval: 0.6 to 0.9), and at 12 months for LTFU, AHR at 24 months: 0.7 (95% confidence interval: 0.7 to 0.7).
Children adherence to clinic visits during the first 6 months of HIV care was associated with a higher risk of death and LTFU, but by 24 months, children with better CCA had a reduced risk of LTFU and mortality.
艾滋病病毒感染者不按时就诊与不良结局相关。我们描述了肯尼亚艾滋病病毒感染儿童的累计就诊依从性（CCA）对死亡率和失访（LTFU）的影响。
我们分析了 2001 年至 2009 年期间在美国国际开发署-学术模式提供医疗保健伙伴关系中肯尼亚的 HIV 感染儿童的回顾性临床数据。我们将 CCA 定义为入组后按天计算的就诊依从性比例。我们在入组时和随时间推移控制人口统计学和临床因素的情况下，检查了 CCA 对死亡和 LTFU 的影响。使用时变系数 Cox 比例风险模型计算了 CCA 每增加 10%与死亡率和 LTFU 相关的调整后的危险比（AHR）。
在 3255 名 HIV 感染儿童中，1668 名（51.2%）为男性，中位入组年龄为 5.2 岁（四分位距：3.6-7.4）。在 2393 名在入组后 3 个月内有 CD4 的儿童中，1125 名（47.0%）严重免疫抑制，567 名失访，88 名死亡。就诊依从性较高的儿童在入组后 3 个月和 6 个月时发生死亡和 LTFU 的风险更高。在入组后 24 个月时，较高的 CCA 对死亡率具有保护作用，AHR 在 24 个月时为 0.7（95%置信区间：0.6-0.9），在入组后 12 个月时对 LTFU 具有保护作用，AHR 在 24 个月时为 0.7（95%置信区间：0.7-0.7）。
在 HIV 护理的前 6 个月内，儿童就诊依从性与死亡和 LTFU 的风险增加相关，但在 24 个月时，就诊依从性较好的儿童发生 LTFU 和死亡率的风险降低。
