International Union against Tuberculosis and Lung Disease (The Union),Mandalay,Myanmar.
Department of Paediatrics,University of Medicine,Mandalay,Myanmar.
Epidemiol Infect. 2019 Jan;147:e206. doi: 10.1017/S0950268819000906.
Retaining adolescents (aged 10-19 years), living with HIV (ALHIV) on antiretroviral therapy (ART) is challenging. In Myanmar, 1269 ALHIV were under an Integrated HIV Care (IHC) Programme by June 2017 and their attrition (death and lost to follow-up) rates were not assessed before. We undertook a cohort study using routinely collected data of ALHIV enrolled into HIV care from July 2005 to June 2017 and assessed their attrition rates in June 2018 by time-to-event analysis. Of 1269 enrolled, 197(16%) and of 1054 initiated ART, 224 (21%) had an attrition defining event. The pre-ART and ART attrition rates were 21.8 (95% CI 19.0-25.1) and 6.4 (95% CI 5.6-7.3) per 100 person-years follow-up, respectively. The factors 'at enrolment' that were associated with higher hazards of attrition were: (1) WHO stage 3 or 4; (2) haemoglobin <10 gm/dl; (3) no documented CD4 cell counts, hepatitis B and C test results; and (4) injection drug use. Baseline hazards were high during the initial 1-2 years and after 5-6 years. The pre-ART and ART attrition rates in ALHIV were lower than those in Africa but higher than the children under IHC. This warrants designing and implementing additional care tailored to the needs of ALHIV under IHC.
留住接受抗反转录病毒治疗（ART）的青少年艾滋病病毒感染者（ALHIV）是一项挑战。截至 2017 年 6 月，缅甸共有 1269 名 ALHIV 参与了综合艾滋病毒护理（IHC）计划，但在此之前，尚未对其流失（死亡和失访）率进行评估。我们使用 2005 年 7 月至 2017 年 6 月期间常规收集的 HIV 护理中登记的 ALHIV 数据开展了一项队列研究，并通过生存分析评估了他们在 2018 年 6 月的流失率。在登记的 1269 名患者中，有 197 名（16%）和 1054 名开始接受 ART 的患者中，有 224 名（21%）发生了定义为流失的事件。在接受 ART 治疗前和 ART 治疗期间，流失率分别为每 100 人年随访 21.8（95%CI19.0-25.1）和 6.4（95%CI5.6-7.3）。“登记时”与更高流失风险相关的因素包括：（1）世卫组织第 3 或 4 期；（2）血红蛋白 <10gm/dl；（3）未记录 CD4 细胞计数、乙型肝炎和丙型肝炎检测结果；（4）静脉注射吸毒。在最初的 1-2 年和 5-6 年后，基线风险较高。ALHIV 的 ART 治疗前和 ART 治疗期间的流失率低于非洲，但高于 IHC 下的儿童。这需要设计和实施针对 IHC 下的 ALHIV 需求的额外护理。
