Anova Health Institute, Johannesburg, South Africa.
Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen, the Netherlands.
Epidemiol Infect. 2021 Mar 22;149:e88. doi: 10.1017/S0950268821000637.
Provision of high-quality care and ensuring retention of children on antiretroviral therapy (ART) are essential to reduce human immunodeficiency virus (HIV)-associated morbidity and mortality. Virological non-suppression (≥1000 viral copies/ml) is an indication of suboptimal HIV care and support. This retrospective cohort study included ART-naïve children who initiated first-line ART between July 2015 and August 2017 in Johannesburg and rural Mopani district. Of 2739 children started on ART, 29.5% (807/2739) were lost to care at the point of analysis in August 2018. Among retained children, overall virological non-suppression was 30.2% (469/1554). Virological non-suppression was associated with higher loss to care 30.3% (229/755) compared with suppressed children (9.7%, 136/1399, P < 0.001). Receiving treatment in Mopani was associated with virological non-suppression in children under 5 years (adjusted odds ratio (aOR) 1.7 (95% confidence interval (CI) 1.1-2.4), 5-9 years (aOR 1.8 (1.1-3.0)) and 10-14 years (aOR 1.9 (1.2-2.8)). Virological non-suppression was associated with lower CD4 count in children 5-9 years (aOR 2.1 (1.1-4.1)) and 10-14 years (aOR 2.1 (1.2-3.8)). Additional factors included a shorter time on ART (<5 years aOR 1.8-3.7 (1.3-8.2)), and male gender (5-9 years, aOR1.5 (1.01-2.3)), and receiving cotrimoxazole prophylaxis (10-14 years aOR 2.0 (1.2-3.6)). In conclusion, virological non-suppression is a factor of subsequent programme loss in both regions, and factors affecting the quality of care need to be addressed to achieve the third UNAIDS 90 in paediatric HIV.
提供高质量的护理并确保接受抗逆转录病毒治疗（ART）的儿童能够持续接受治疗，对于降低与人类免疫缺陷病毒（HIV）相关的发病率和死亡率至关重要。病毒学未能抑制（≥1000 个病毒拷贝/ml）表明 HIV 护理和支持存在不足。这项回顾性队列研究纳入了 2015 年 7 月至 2017 年 8 月期间在约翰内斯堡和农村莫帕尼区首次接受一线 ART 的 ART 初治儿童。在开始接受 ART 的 2739 名儿童中，2018 年 8 月分析时，有 29.5%（807/2739）失去了护理。在保留的儿童中，总体病毒学抑制率为 30.2%（469/1554）。与病毒学抑制的儿童（9.7%，136/1399，P<0.001）相比，失去护理的儿童中病毒学抑制率更高（30.3%，229/755）。在 5 岁以下儿童（调整后的优势比（aOR）为 1.7（95%置信区间（CI）为 1.1-2.4））、5-9 岁儿童（aOR 为 1.8（1.1-3.0））和 10-14 岁儿童（aOR 为 1.9（1.2-2.8））中，在莫帕尼接受治疗与病毒学抑制不良相关。在 5-9 岁（aOR 2.1（1.1-4.1））和 10-14 岁（aOR 2.1（1.2-3.8））儿童中，病毒学抑制不良与 CD4 计数较低相关。其他因素包括接受 ART 治疗的时间较短（<5 年 aOR 1.8-3.7（1.3-8.2））、男性（5-9 岁，aOR 1.5（1.01-2.3））和接受复方新诺明预防（10-14 岁 aOR 2.0（1.2-3.6））。总之，病毒学抑制不良是两个地区后续方案失败的一个因素，需要解决影响护理质量的因素，以实现儿童艾滋病防治的第三个 90 目标。
