Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India.
UNICEF, Near 73, Lodhi Gardens, Lodhi Estate, New Delhi, 110003, India.
Curr HIV Res. 2021;19(3):201-215. doi: 10.2174/1573399817666210104102825.
To evaluate the effectiveness of telemedicine in the clinical management of children living with HIV/AIDS in resource-limited settings ; Background: Telemedicine is an important mechanism for service delivery in health care settings, both in resource-rich and resource-poor settings. Such service delivery mechanisms have shown to be associated with virologic suppression and higher CD4 counts. These services are also associated with improved access, shorter visiting times, and higher patient satisfaction. ; Objective: We designed the present two-group comparison study to compare the clinical evaluation and management of children in the anti-retroviral therapy (ART) centres linked to telemedicine facility with those who are not linked to this facility in Maharashtra, India. ; Methods: We analysed clinical records from six ART centres in Maharashtra; of these, 250 children were in the linked ART centres and 301 were in the non-linked ART centres. The outcomes were classified according to investigations, management, and monitoring. For management, we evaluated: 1) Initiation of cotrimoxazole prophylaxis; 2) Children not initiated on ART when required; 3) ART regime after appropriate investigations; and 4) Change of regime (if immunologically indicated). For monitoring, we assessed the haematological monitoring of children on ART. ; Results: The mean (SD) ages of children in linked and non-linked ART centres were 10.8 (4.6) and 10.9 (4.6) years, respectively (p=0.80). After adjusting for individual and structural level variables, physical examination (OR: 2.0, 95% CI; 1.2, 3.2), screening for tuberculosis (OR: 12.9, 95% CI: 2.0, 82.9) and cotrimoxazole prophylaxis were significantly more likely in the linked centres compared with non-linked centres (OR: 1.8, 95% CI: 1.4, 2.2). A higher proportion of children eligible for ART were not initiated on treatment in the non-linked centres compared with linked centres (26% vs. 8%, p=0.06). Children were less likely to be initiated on zidovudine-based regimens without baseline haemoglobin or with baseline haemoglobin of less than 9 gm% in linked centres (OR: 0.7, 95% CI: 0.6, 0.8). Similarly, children in the linked centres were less likely to have been started on nevirapine-based regimens without baseline liver enzymes (OR: 0.8, 95% CI: 0.7, 0.9). ; Conclusion: Thus, the overall clinical management of Children Living with HIV/ AIDS (CLHA) was better in ART centres linked with the telemedicine initiative compared with those who were not linked. Children in the linked ART centres were more likely to have a complete baseline assessment (physical, hematological, radiological, and screening for TB); the presence of a pediatrician in the centres was helpful.
我们设计了这项前瞻性、群组比较研究，以比较印度马哈拉施特拉邦通过远程医疗设施与未通过该设施连接的抗逆转录病毒治疗（ART）中心的儿童的临床评估和管理。
我们分析了马哈拉施特拉邦六个 ART 中心的临床记录；其中，250 名儿童在有远程医疗设施的 ART 中心，301 名儿童在没有远程医疗设施的 ART 中心。结果根据检查、管理和监测进行分类。在管理方面，我们评估了：1）启动复方新诺明预防；2）当需要时未开始 ART 的儿童；3）适当检查后的 ART 方案；4）方案变更（如果免疫指示）。在监测方面，我们评估了接受 ART 治疗的儿童的血液学监测。
有远程医疗设施和无远程医疗设施的 ART 中心儿童的平均（SD）年龄分别为 10.8（4.6）和 10.9（4.6）岁（p=0.80）。调整个体和结构变量后，与无远程医疗设施的 ART 中心相比，体格检查（比值比：2.0，95%置信区间；1.2，3.2）、结核病筛查（比值比：12.9，95%置信区间：2.0，82.9）和复方新诺明预防更有可能在有远程医疗设施的 ART 中心进行（比值比：1.8，95%置信区间：1.4，2.2）。无远程医疗设施的 ART 中心中，更多符合条件的儿童未开始接受治疗，而不是有远程医疗设施的 ART 中心（26%对 8%，p=0.06）。基线血红蛋白低于 9 克/分升或基线血红蛋白低于 9 克/分升时，无基线肝酶的儿童不太可能开始使用齐多夫定为基础的方案（比值比：0.7，95%置信区间：0.6，0.8）。同样，无基线肝酶的儿童不太可能开始使用奈韦拉平为基础的方案（比值比：0.8，95%置信区间：0.7，0.9）。
因此，与未连接的远程医疗倡议的 ART 中心相比，通过远程医疗倡议连接的 ART 中心的儿童整体临床管理更好。有远程医疗设施的 ART 中心的儿童更有可能进行完整的基线评估（身体、血液、放射和结核病筛查）；中心有儿科医生存在有助于评估。
