Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2018 Apr 9;13(4):e0195372. doi: 10.1371/journal.pone.0195372. eCollection 2018.
High mortality among adolescents with HIV reflects delays and failures in the care cascade. We sought to elucidate critical missed opportunities and barriers to care among adolescents hospitalized with HIV at Botswana's tertiary referral hospital. We enrolled all HIV-infected adolescents (aged 10-19 years) hospitalized with any diagnosis other than pregnancy from July 2015 to January 2016. Medical records were reviewed for clinical variables and past engagement in care. Semi-structured interviews of the adolescents (when feasible) and their caregivers explored delays and barriers to care. Twenty-one eligible adolescents were identified and 15 were enrolled. All but one were WHO Clinical Stage 3 or 4. Barriers to diagnosis included lack of awareness about perinatal HIV infection, illness or death of the mother, and fear of discrimination. Barriers to adherence to antiretroviral therapy included nondisclosure, isolation, and mental health concerns. The number of hospitalized HIV-infected adolescents was lower than expected. However, among those hospitalized, the lack of timely diagnosis and subsequent gaps in the care cascade elucidated opportunities to improve outcomes and quality of life for this vulnerable group.
HIV 青少年患者的高死亡率反映了关怀链中的延迟和失败。我们旨在阐明博茨瓦纳三级转诊医院因任何非妊娠诊断而住院的 HIV 感染青少年患者的关键错失机会和关怀障碍。我们招募了所有因任何非妊娠诊断而住院的 HIV 感染青少年（10-19 岁），时间为 2015 年 7 月至 2016 年 1 月。对病历进行了临床变量和过去参与关怀的回顾。对青少年（在可行时）及其照顾者进行半结构化访谈，以探讨关怀延误和障碍。确定了 21 名符合条件的青少年，其中 15 名被纳入研究。除 1 人外，所有患者均为世界卫生组织临床分期 3 或 4 期。诊断障碍包括对围产期 HIV 感染、母亲的疾病或死亡缺乏认识，以及对歧视的恐惧。抗逆转录病毒治疗依从性障碍包括不公开、孤立和心理健康问题。住院的 HIV 感染青少年人数低于预期。然而，在那些住院的患者中，缺乏及时的诊断以及随后关怀链中的差距，阐明了为这一弱势群体改善预后和生活质量的机会。
