Jolly Pauline, Padilla Luz A, Ahmed Charisse, Harris Chantal, Mthethwa Nobuhle, Jha Megha, Ba Inessa, Styles Amy, Hope Sarah P, Brooks Raina, Naluyinda-Kitabire Florence, Mamba Makhosini, Preko Peter
a University of Alabama at Birmingham School of Public Health , Birmingham , Alabama , USA.
b Swaziland National AIDS Programme, National Pediatric HIV Care & Treatment Office , Mbabane , Swaziland.
Afr J AIDS Res. 2018 Jul;17(2):193-202. doi: 10.2989/16085906.2018.1488266.
Although early antiretroviral therapy (ART) reduces HIV-related mortality in children by up to 75%, almost half of HIV-positive children younger than 1 year old in Swaziland do not initiate ART. This study was conducted to identify barriers to early ART initiation among HIV-positive infants. This was a case-control study among HIV-positive infants, aged 2 to 18 months, who either did not initiate ART (cases), or initiated ART (controls), during 18 months after testing. Multivariable logistic regression showed that infants who visited the clinic every month, or every 2 months, were 5.78 and 6.20 times more likely to initiate ART than those who visited less often (OR 5.78, 95% CI 1.82-18.33 and OR 6.20, 95% CI 1.30-29.60 respectively). Children who lived ≤30 and 31-60 minutes from the nearest clinic were 84% and 79% less likely respectively to initiate ART (OR 0.16, 95% CI 0.03-0.78 and OR 0.21, 95% CI 0.04-0.98) compared with those who lived more than 60 minutes away. Children who received immunisation after 6 months were 22.59 times more likely to initiate ART (OR 22.59, 95% CI 7.00-21.72) than those who did not. Infants of caregivers who had excellent or good relationships with their healthcare provider were 4.32 times more likely to initiate ART (OR 4.32, 95% CI 1.01-18.59) than those of caregivers who had average or poor relationships with healthcare providers. The significant predictors of ART initiation identified in this study should be regarded as priority areas for intervention among HIV-positive women in Swaziland.
尽管早期抗逆转录病毒疗法（ART）可将儿童与艾滋病相关的死亡率降低多达75%，但斯威士兰几乎一半的1岁以下艾滋病病毒呈阳性儿童未开始接受ART治疗。开展这项研究是为了确定艾滋病病毒呈阳性婴儿早期开始接受ART治疗的障碍。这是一项针对2至18个月大的艾滋病病毒呈阳性婴儿的病例对照研究，这些婴儿在检测后的18个月内要么未开始接受ART治疗（病例组），要么开始接受了ART治疗（对照组）。多变量逻辑回归分析显示，每月或每两个月就诊一次诊所的婴儿开始接受ART治疗的可能性分别是就诊频率较低的婴儿的5.78倍和6.20倍（比值比5.78，95%置信区间1.82 - 18.33；比值比6.20，95%置信区间1.30 - 29.60）。与居住在距离最近诊所超过60分钟路程的儿童相比，居住在距离诊所≤30分钟和31 - 60分钟路程的儿童开始接受ART治疗的可能性分别降低了84%和79%（比值比0.16，95%置信区间0.03 - 0.78；比值比0.21，95%置信区间0.04 - 0.98）。6个月后接受免疫接种的儿童开始接受ART治疗的可能性是未接受免疫接种儿童的22.59倍（比值比22.59，95%置信区间7.00 - 21.72）。与医疗服务提供者关系良好或优秀的照料者所照顾的婴儿开始接受ART治疗的可能性是与医疗服务提供者关系一般或较差的照料者所照顾婴儿的4.32倍（比值比4.32，95%置信区间1.01 - 18.59）。本研究中确定的开始接受ART治疗的显著预测因素应被视为斯威士兰艾滋病病毒呈阳性女性干预的优先领域。
