2009 - 2013年莫桑比克接受艾滋病护理儿童的治疗结果

Outcomes Among Children Enrolled in HIV Care in Mozambique 2009-2013.

作者信息

Teasdale Chloe A, Yang Jingyan, Thome Beatriz, Yersin Isabelle, Sebastian Thresia, Brusamento Serena, Lahuerta Maria, Jobarteh Kebba M, Abrams Elaine J

机构信息

From the *ICAP-Columbia University, †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and ‡US Centers for Disease Control and Prevention, Maputo, Mozambique.

出版信息

Pediatr Infect Dis J. 2016 Oct;35(10):1117-25. doi: 10.1097/INF.0000000000001259.

DOI:10.1097/INF.0000000000001259

PMID:27622685

Abstract

BACKGROUND

Scale-up of HIV care and antiretroviral therapy (ART) services for children has expanded access, but significant gaps and challenges remain. We examined lost to follow-up (LTF) and mortality in a large cohort of children enrolled in HIV care in Mozambique.

METHODS

Routinely collected medical data on children 0-14 years enrolled in care 2009-2013 at ICAP-supported health facilities in 5 provinces of Mozambique were used. Children not receiving ART (pre-ART) were considered LTF if they did not a have a visit within 12 months of the end of data collection; for those receiving ART, LTF was no visit within 6 months. Competing risk and Kaplan-Meier estimators were used, respectively, to estimate pre-ART and on ART LTF and mortality.

RESULTS

A total of 13,695 children enrolled in HIV care at 64 health facilities (48.6%, <2 years), and 7733 (56.5%) initiated ART during follow-up. Cumulative incidence of pre-ART LTF was 32.9% [95% confidence interval (CI): 32.1-33.7] and 34.4% (95% CI: 33.6-35.2) by 12 and 24 months, respectively, and was highest in children <5 years (12-month LTF in children 2-4 years, 34.2%, 95% CI: 32.6-35.9). Pre-ART mortality at 12 months was 3.3% (95% CI: 3.0-3.6) and was highest in children <2 years (4.1%, 95% CI: 3.6-4.6). On ART, LTF was 28.6% (95% CI: 27.6-29.7) and 37.6 (95% CI: 36.4-38.8) at 12 and 24 months, and 12 months mortality after ART was 8.0% (95% CI: 7.3-8.7).

CONCLUSIONS

High rates of LTF were observed in this large cohort of HIV-infected children accessing care in Mozambique both before and after ART initiation highlighting the urgent need for interventions to improve retention in routine care settings.

摘要

背景

扩大针对儿童的艾滋病护理和抗逆转录病毒疗法（ART）服务已增加了可及性，但仍存在重大差距和挑战。我们调查了莫桑比克一大群接受艾滋病护理儿童的失访（LTF）和死亡率情况。

方法

使用了2009年至2013年在莫桑比克5个省份由ICAP支持的医疗机构中登记接受护理的0至14岁儿童的常规收集医疗数据。未接受ART（ART治疗前）的儿童如果在数据收集结束后12个月内没有就诊，则被视为失访；对于接受ART治疗的儿童，失访定义为6个月内没有就诊。分别使用竞争风险和Kaplan-Meier估计量来估计ART治疗前和治疗期间的失访率和死亡率。

结果

共有13695名儿童在64个医疗机构登记接受艾滋病护理（48.6%，<2岁），7733名（56.5%）在随访期间开始接受ART治疗。ART治疗前12个月和24个月的累积失访率分别为32.9%[95%置信区间（CI）：32.1 - 33.7]和34.4%（95% CI：33.6 - 35.2），在<5岁儿童中最高（2 - 4岁儿童12个月失访率为34.2%，95% CI：32.6 - 35.9）。ART治疗前12个月的死亡率为3.3%（95% CI：3.0 - 3.6），在<2岁儿童中最高（4.1%，95% CI：3.6 - 4.6）。接受ART治疗后，12个月和24个月的失访率分别为28.6%（95% CI：27.6 - 29.7）和37.6（95% CI：36.4 - 38.8），ART治疗后12个月的死亡率为8.0%（95% CI：7.3 - 8.7）。