Somi G, Majigo M, Manyahi J, Nondi J, Agricola J, Sambu V, Todd J, Rwebembera A, Makyao N, Ramadhani A, Matee Min
National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Mwanza, Tanzania.
Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Mwanza, Tanzania.
BMC Health Serv Res. 2017 Aug 7;17(1):540. doi: 10.1186/s12913-017-2492-9.
Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania.
The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods.
A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0-14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2-3% of children were positive for TB, and 2-4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26-35), 43% (40-47), 52% (49-55) and 61% (58-64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10-15% higher survival over time.
Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered.
提高感染艾滋病毒儿童的存活率仍然是一项重要的卫生议程。我们介绍了坦桑尼亚为感染艾滋病毒儿童提供护理和治疗服务的进展情况。
利用国家艾滋病控制规划护理与治疗（CTC 2）数据库获取2011年1月至2014年12月期间登记参加艾滋病毒护理与治疗项目的所有0至14岁儿童的信息。我们使用Kaplan-Meier方法评估了抗逆转录病毒治疗（ART）的资格、从登记到开始接受ART的时间、营养状况和死亡率。
在此期间，共有29531名（14304名男孩和15227名女孩）未接受过ART治疗的0至14岁儿童登记入组，每年约6700至8000名儿童。男女比例为48:50。登记时，72%的儿童符合接受ART治疗的条件，2%-3%的儿童结核检测呈阳性，2%-4%的儿童严重营养不良。2011年至2014年期间，2368名（8%）儿童死亡，9243名（31%）儿童失访，17920名（61%）儿童接受护理或ART治疗。1岁、2岁、5岁和10岁儿童的死亡概率分别为31%（95%置信区间26-35）、43%（40-47）、52%（49-55）和61%（58-64）。死亡风险在非常年幼的年龄（<2岁）时最高，到4岁时急剧下降。接受ART治疗的儿童随着时间推移存活率高出约10%-15%。
坦桑尼亚在提供儿科艾滋病毒护理和治疗方面取得了重大进展。平均每年有7000名儿童登记入组，并且在2岁以下被诊断出的儿童中，约三分之二在一个月内开始接受ART治疗。儿童一旦被诊断就立即提供ART治疗是提高存活率的最大因素。然而，我们注意到：i）大多数儿童在登记时病情已发展；ii）约三分之二的儿童缺少基线CD4检测值，只有35%的儿童记录了CD4细胞计数或百分比，这表明获得CD4检测服务的机会有限；iii）31%的儿童失访（LTFU）。需要应对这些挑战，以改善艾滋病毒感染儿童的早期检测、登记和护理留存率，并改进所提供服务的记录。
