From the Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
Pediatr Infect Dis J. 2020 May;39(5):429-434. doi: 10.1097/INF.0000000000002612.
There are 170,000 children living with HIV in 2017 in Mozambique. Scaling-up HIV care requires effective retention along the cascade. We sought to evaluate the pediatric cascade in HIV care at the Manhiça District Hospital.
A prospective cohort of children <15 years was followed from enrollment in HIV care (January 2013 to December 2015) until December 2016. Loss to follow-up (LTFU) was defined as not attending the HIV hospital visits for ≥90 days following last visit attended.
From the 438 children included {median age at enrollment in care of 3,6 [interquartile range (IQR): 1.1-8.6] years}, 335 (76%) were antiretroviral therapy (ART) eligible and among those, 263 (78%) started ART at enrollment in HIV care. A total of 362 children initiated ART during the study period and the incidence rate of LTFU at 12, 24, and 36 months post-ART initiation was 41 [95% confidence interval (CI): 34-50], 34 (95% CI: 29-41), and 31 (95% CI: 27-37) per 100 children-years, respectively. Median time to LTFU was 5.8 (IQR: 1.4-12.7) months. Children 5-9 years of age had a lower risk of LTFU compared with children <1 year [adjusted subhazard ratio 0.36 (95% CI: 0.20-0.61)]. Re-engagement in care (RIC) was observed in 25% of the LTFU children.
The high LTFU found in this study highlights the special attention that should be given to younger children during the first 6 months post-ART initiation to prevent LTFU. Once LTFU, only a quarter of those children return to the health unit. Elucidating factors associated with RIC could help to fine tune interventions which promote RIC.
2017 年，莫桑比克有 17 万名儿童感染艾滋病毒。扩大艾滋病毒护理服务需要沿着护理连续体实现有效的保留。我们试图评估马尼卡地区医院的儿童艾滋病毒护理连续体。
对 2013 年 1 月至 2015 年 12 月期间参加艾滋病毒护理的<15 岁儿童进行前瞻性队列研究，直到 2016 年 12 月。失访（LTFU）定义为最后一次就诊后≥90 天未参加 HIV 医院就诊。
在纳入的 438 名儿童中（中位年龄为 3 岁 6 个月，[四分位距：1.1-8.6]岁），335 名（76%）符合抗逆转录病毒治疗（ART）条件，其中 263 名（78%）在开始接受 HIV 护理时开始接受 ART。在研究期间，共有 362 名儿童开始接受 ART，ART 开始后 12、24 和 36 个月时 LTFU 的发生率分别为 41 例[95%可信区间（CI）：34-50]、34 例[95%CI：29-41]和 31 例[95%CI：27-37]每 100 儿童年，分别。LTFU 的中位时间为 5.8 个月（IQR：1.4-12.7）。与<1 岁的儿童相比，5-9 岁的儿童 LTFU 的风险较低[调整后的亚风险比 0.36（95%CI：0.20-0.61）]。LTFU 的 25%儿童重新开始接受治疗。
本研究发现的高失访率突显了在 ART 开始后前 6 个月内应特别关注年龄较小的儿童，以防止失访。一旦失访，只有四分之一的儿童返回卫生单位。阐明与 RIC 相关的因素有助于调整促进 RIC 的干预措施。
