Biomedical Research and Training Institute, Harare, Zimbabwe.
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Trop Med Int Health. 2018 Feb;23(2):149-155. doi: 10.1111/tmi.13012. Epub 2017 Dec 26.
Increasing numbers of children with HIV are surviving to adolescence and encountering multiple clinical and social consequences of long-standing HIV infection. We aimed to investigate the association between HIV and disability, social functioning and school inclusion among 6- to 16-year-olds in Zimbabwe.
HIV-infected children receiving antiretroviral therapy from a public-sector HIV clinic and HIV-uninfected children attending primary care clinics in the same catchment area were recruited. Standardised questionnaires were used to collect socio-demographic, social functioning and disability data. Multivariable logistic regression was used to assess the relationship between HIV status and disability and functioning.
We recruited 202 HIV-infected and 285 HIV-uninfected children. There was no difference in age and gender between the two groups, but a higher proportion of HIV-infected children were orphaned. The prevalence of any disability was higher in HIV-infected than uninfected children (37.6% vs. 18.5%, P < 0.001). HIV-infected children were more likely to report anxiety (adjusted odds ratio (aOR) 4.4; 95% CI 2.4, 8.1), low mood (aOR 4.2; 2.1, 8.4) and difficulty forming friendships (aOR 14.8; 1.9, 116.6) than uninfected children. Children with HIV also reported more missed school days, repeating a school year and social exclusion in class. These associations remained apparent when comparing children with HIV and disability to those with HIV but no disabilities.
Children with HIV commonly experience disabilities, and this is associated with social and educational exclusion. Rehabilitation and support services are needed to facilitate educational attainment and social participation in this group.
越来越多的 HIV 患儿存活至青春期，并遭遇长期 HIV 感染导致的多种临床和社会后果。本研究旨在调查津巴布韦 6 至 16 岁 HIV 患儿中 HIV 感染与残疾、社会功能和学校融入的关系。
我们招募了在公立 HIV 诊所接受抗逆转录病毒治疗的 HIV 感染儿童和同一服务区内初级保健诊所就诊的 HIV 未感染儿童。采用标准化问卷收集社会人口学、社会功能和残疾数据。多变量逻辑回归用于评估 HIV 感染状况与残疾和功能之间的关系。
我们招募了 202 名 HIV 感染和 285 名 HIV 未感染儿童。两组儿童的年龄和性别无差异，但 HIV 感染儿童中孤儿比例更高。与 HIV 未感染儿童相比，HIV 感染儿童的残疾发生率更高（37.6% vs. 18.5%，P < 0.001）。HIV 感染儿童更有可能报告焦虑（调整后的优势比（aOR）4.4；95%CI 2.4，8.1）、情绪低落（aOR 4.2；2.1，8.4）和交友困难（aOR 14.8；1.9，116.6）。与 HIV 未感染儿童相比，HIV 感染儿童也报告了更多的缺课日、重读学年和课堂社交排斥。当比较 HIV 感染且有残疾的儿童与 HIV 感染但无残疾的儿童时，这些关联仍然存在。
HIV 感染儿童普遍存在残疾，这与社会和教育排斥有关。需要康复和支持服务来促进这一群体的教育成就和社会参与。
