Nhampossa Tacilta, Fernandez Sheila, Augusto Orvalho, Fuente-Soro Laura, Maculuve S Ó Nia, Bernardo Edson, Saura Anna, Casellas Aina, Gonzalez Raquel, Ruperez Maria, Karajeans Esmeralda, Vaz Paula, Menendez Clara, Buck W Chris, Naniche Denise, Lopez-Varela Elisa
Centro de Investigação em Saúde de Manhiça (CISM).
Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique.
Medicine (Baltimore). 2020 Aug 7;99(32):e21410. doi: 10.1097/MD.0000000000021410.
It is often assumed that children and their caregivers either stay in care together or discontinue together, but data is lacking on caregiver-child retention concordance. We sought to describe the pattern of care among a cohort of human immunodeficiency virus (HIV) infected children and mothers enrolled in care at the Manhiça District Hospital (MDH).This was a retrospective review of routine HIV clinical data collected under a larger prospective HIV cohort study at MDH. Children enrolling HIV care from January 2013 to November 2016 were identified and matched to their mother's HIV clinical data. Retention in care for mothers and children was assessed at 24 months after the child's enrolment. Multinomial logistic regression was performed to evaluate variables associated with retention discordance.For the 351 mother-child pairs included in the study, only 39% of mothers had concordant care status at baseline (23% already active in care, 16% initiated care concurrently with their children). At 24-months follow up, a total of 108 (31%) mother-child pairs were concordantly retained in care, 88 (26%) pairs were concordantly lost to follow up (LTFU), and 149 (43%) had discordant retention. Pairs with concurrent registration had a higher probability of being concordantly retained in care. Children who presented with advanced clinical or immunological stage had increased probability of being concordantly LTFU.High rates of LTFU as well as high proportions of discordant retention among mother-child pairs were found. Prioritization of a family-based care model that has the potential to improve retention for children and caregivers is recommended.
人们常常认为儿童及其照料者要么一起接受照料，要么一起中断照料，但缺乏关于照料者与儿童留用一致性的数据。我们试图描述在曼希卡区医院（MDH）登记接受照料的一组感染人类免疫缺陷病毒（HIV）的儿童及其母亲的照料模式。
这是对在MDH一项更大的前瞻性HIV队列研究中收集的常规HIV临床数据的回顾性分析。确定了2013年1月至2016年11月登记接受HIV照料的儿童，并将其与母亲的HIV临床数据进行匹配。在儿童登记后24个月评估母亲和儿童的照料留用情况。进行多项逻辑回归以评估与留用不一致相关的变量。
对于纳入研究的351对母婴，只有39%的母亲在基线时照料状态一致（23%已在接受照料，16%与孩子同时开始接受照料）。在24个月的随访中，共有108对（31%）母婴一致地继续接受照料，88对（26%）一致地失访（LTFU），149对（43%）留用情况不一致。同时登记的母婴对一致地继续接受照料可能性更高。呈现晚期临床或免疫阶段的儿童一致地失访可能性增加。
发现母婴对中失访率高以及留用情况不一致的比例高。建议优先采用有可能改善儿童和照料者留用情况的家庭式照料模式。
