Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA.
Matern Child Health J. 2020 Jun;24(6):739-747. doi: 10.1007/s10995-020-02909-3.
Early initiation of antiretroviral therapy (ART, before 12 weeks of age) among infants living with HIV reduces infant mortality and slows disease progression. However, inefficiencies in early infant diagnosis processes prevents timely ART initiation among infants living with HIV in Kenya. This study assesses predictors of early ART initiation among infants living with HIV in Kenya.
We retrospectively reviewed data from 96 infants living with HIV born between January 2013 and June 2017 at 6 Kenyan government hospitals.
The primary outcome was infant receipt of ART by 12 weeks of age. We assessed bivariable and multivariable predictors of ART initiation by 12 weeks of age.
Among 96 infants living with HIV, 82 (85.4%) infants initiated ART at a median infant age of 17.1 weeks. Of the 82 infants who started ART, only 17 (20.7%) initiated ART by 12 weeks of age. In multivariable logistic regression analyses, testing per national guidelines (< 7 weeks of age) (aOR 40.14 [3.96-406.97], p = 0.002), shorter turnaround time for result notification (≤ 4 weeks) (aOR 11.30 [2.02-63.34], p = 0.006), and ART initiation within 3 days of mother notification (aOR 7.32 [1.41-38.03], p = 0.006) were significantly associated with ART initiation by 12 weeks of age.
Current implementation of early infant diagnosis services in Kenyan only achieves targets for early ART initiation in one-fifth of infants with HIV. Strengthening services to support earlier infant testing and streamlined processes for early infant diagnosis may increase the proportion of infants who receive timely ART.
在感染艾滋病毒的婴儿中尽早开始抗逆转录病毒治疗（ART，在 12 周龄之前）可以降低婴儿死亡率并减缓疾病进展。然而，肯尼亚早期婴儿诊断过程中的效率低下阻碍了感染艾滋病毒的婴儿及时开始接受 ART 治疗。本研究评估了肯尼亚感染艾滋病毒的婴儿早期开始 ART 的预测因素。
我们回顾性分析了 2013 年 1 月至 2017 年 6 月期间在肯尼亚 6 家政府医院出生的 96 名感染艾滋病毒的婴儿的数据。
主要结局是婴儿在 12 周龄时接受 ART 治疗。我们评估了 12 周龄前开始 ART 的婴儿的两变量和多变量预测因素。
在 96 名感染艾滋病毒的婴儿中，82 名（85.4%）婴儿在婴儿年龄中位数为 17.1 周时开始接受 ART。在开始接受 ART 的 82 名婴儿中，只有 17 名（20.7%）在 12 周龄时开始接受 ART。在多变量逻辑回归分析中，按照国家指南进行检测（<7 周龄）（调整优势比 40.14 [3.96-406.97]，p=0.002）、结果通知的周转时间更短（≤4 周）（调整优势比 11.30 [2.02-63.34]，p=0.006）和母亲通知后 3 天内开始接受 ART（调整优势比 7.32 [1.41-38.03]，p=0.006）与 12 周龄时开始接受 ART 显著相关。
肯尼亚目前实施的早期婴儿诊断服务仅使五分之一的 HIV 感染婴儿达到了早期开始 ART 的目标。加强服务以支持更早的婴儿检测和简化早期婴儿诊断流程，可能会增加及时接受 ART 的婴儿比例。
