Auld Andrew F, Alfredo Charity, Macassa Eugenia, Jobarteh Kebba, Shiraishi Ray W, Rivadeneira Emilia D, Houston James, Spira Thomas J, Ellerbrock Tedd V, Vaz Paula
From the *Division of Global HIV/AIDS, Centers For Disease Control and Prevention, Atlanta, Georgia; †Division of Global HIV/AIDS, Centers For Disease Control and Prevention, Maputo, Mozambique; ‡Ministerio Da Saude, Programa TARV Pediatrico, Maputo, Mozambique; and §Fundação Ariel Glaser Contra O SIDA Pediátrico, Maputo, Mozambique.
Pediatr Infect Dis J. 2015 Aug;34(8):e191-9. doi: 10.1097/INF.0000000000000741.
During 2004-2009, >12,000 children (<15 years old) initiated antiretroviral therapy (ART) in Mozambique. Nationally representative outcomes and temporal trends in outcomes were investigated.
Rates of death, loss to follow-up (LTFU) and attrition (death or LTFU) were evaluated in a nationally representative sample of 1054 children, who initiated ART during 2004-2009 at 25 facilities randomly selected using probability-proportional-to-size sampling.
At ART initiation during 2004-2009, 50% were male; median age was 3.3 years; median CD4% was 13%; median CD4 count was 375 cells/μL; median weight-for-age Z score was -2.1. During 2004-2009, median time from HIV diagnosis to care initiation declined from 33 to 0 days (P = 0.001); median time from care to ART declined from 93 to 62 days (P = 0.004); the percentage aged <2 at ART initiation increased from 16% to 48% (P = 0.021); the percentage of patients with prior tuberculosis declined from 50% to 10% (P = 0.009); and the percentage with prior lymphocytic interstitial pneumonia declined from 16% to 1% (P < 0.001). Over 2652 person-years of ART, 183 children became LTFU and 26 died. Twelve-month attrition was 11% overall but increased from 3% to 22% during 2004-2009, mainly because of increases in 12-month LTFU (from 3% to 18%).
Declines in the prevalence of markers of advanced HIV disease at ART initiation probably reflect increasing ART access. However, 12-month LTFU increased during program expansion, and this negated any program improvements in outcomes that might have resulted from earlier ART initiation.
2004年至2009年期间，莫桑比克有超过12,000名15岁以下儿童开始接受抗逆转录病毒治疗（ART）。对具有全国代表性的治疗结果及结果的时间趋势进行了调查。
在1054名儿童的全国代表性样本中评估死亡、失访（LTFU）和损耗（死亡或LTFU）发生率，这些儿童于2004年至2009年期间在25家使用按规模大小概率抽样随机选择的医疗机构开始接受ART治疗。
在2004年至2009年开始接受ART治疗时，50%为男性；中位年龄为3.3岁；中位CD4%为13%；中位CD4细胞计数为375个/μL；年龄别体重Z评分中位数为-2.1。在2004年至2009年期间，从HIV诊断到开始治疗的中位时间从33天降至0天（P = 0.001）；从开始治疗到接受ART的中位时间从93天降至62天（P = 0.004）；开始接受ART治疗时年龄小于2岁的百分比从16%增至48%（P = 0.021）；既往有结核病的患者百分比从50%降至10%（P = 0.009）；既往有淋巴细胞性间质性肺炎的百分比从16%降至1%（P < 0.001）。在超过2652人年的ART治疗期间，183名儿童失访，26名儿童死亡。总体12个月损耗率为11%，但在2004年至2009年期间从3%增至22%，主要是因为12个月失访率增加（从3%增至18%）。
开始接受ART治疗时晚期HIV疾病标志物患病率的下降可能反映了获得ART治疗的机会增加。然而，在项目扩大期间12个月失访率增加，这抵消了因更早开始接受ART治疗可能带来的项目结果方面的任何改善。
