David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
London School of Hygiene and Tropical Medicine, London, UK.
AIDS Res Ther. 2021 Jan 9;18(1):3. doi: 10.1186/s12981-020-00325-9.
Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique.
A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0-14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data.
Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001).
Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.
小儿结核病（TB）、人类免疫缺陷病毒（HIV）和 TB-HIV 合并感染是存在循证诊断和治疗方案的健康问题，这些方案可以降低发病率和死亡率。在许多资源有限的环境中，实施和操作障碍会影响对指南的遵循，从而对患者的结局产生负面影响。本研究旨在评估莫桑比克儿科 HIV 和 TB 护理级联中的表现。
对 2012 年至 2016 年期间常规 PEPFAR 现场级别的 HIV 和 TB 数据进行了回顾性分析。纳入年龄 0-14 岁的患者。使用描述性统计来报告 TB 和 HIV 指标的趋势。使用 2016 年的数据，通过线性回归评估现场级别的变量与儿科 TB 和 HIV 护理级联表现之间的关联。
2016 年，TB 规划中几乎所有（99%）感染儿童都接受了常规 HIV 检测，96%接受了复方磺胺甲噁唑预防，抗逆转录病毒治疗（ART）的起始率较低，为 87%，但从 2012 年到 2016 年稳步提高。从 HIV 规划来看，在最后一次就诊时进行的 TB 筛查在研究期间稳步上升，2016 年达到 82%。在所有省份，新登记的儿童中，接受 TB 治疗或异烟肼预防性治疗（IPT）的比例也稳步提高，但在 2016 年仅为 42%。规模较大的地点在 2016 年更有可能完成儿科 HIV 和 TB 护理级联（p 值范围为 0.05 至<0.001）。
莫桑比克在改善儿童 TB 和 HIV 护理级联方面取得了重大进展，但在 TB 诊断和预防方面仍有错失的机会，IPT 的应用尤其成问题。需要加强 TB/HIV 规划，继续关注儿科 ART 的扩大，同时改善 TB 预防性治疗的提供，无论是为符合条件的儿童提供 IPT 还是更新的利福喷丁为基础的方案。
