Pakistan Field Epidemiology and Laboratory Training Program, Pakistan National Institute of Health Islamabad, Pakistan.
Centers for Disease Control and Prevention, Division of Global HIV/AIDS and Tuberculosis.
J Acquir Immune Defic Syndr. 2022 Feb 1;89(2):121-128. doi: 10.1097/QAI.0000000000002845.
From April to June 2019, a total of 909 new HIV infections were identified in Larkana, Pakistan; 86% was children younger than 15 years. To identify the possible transmission links in this outbreak, a case-control study was conducted in June 2019.
For cases, we selected a systematic random sample of 100 HIV-positive children from the screening list. We chose 2 age-matched and sex-matched controls from the neighborhood of each HIV-positive case. All selected children were tested using the World Health Organization-approved rapid diagnosis test algorithm. We interviewed the parents of each selected child about previous exposures to parenteral treatment and compared exposures of case and control children using conditional logistic regression.
The ages of the selected children ranged from 1 month to 10 years. More than 90% of both HIV+ and HIV- children had received outpatient health care from MBBS-qualified private physicians. Eighty-three percent of HIV+ children versus 46% of HIV- children had received health care from one private physician [adjusted odds ratio (aOR) = 29, 95% confidence interval (95% CI): 10 to 79]. Intravenous infusions during the last outpatient visit were reported by 29% of case versus 7% of controls (aOR 57, 95% CI: 2.9 to >1000), whereas no case children and 17% of control children had received only intramuscular injections (aOR 0, 95% CI: 0 to 41). Among cases, 94% had been given infusions through a drip set compared with 85% of control children (aOR = 7.7, 95% CI: 2.3 to 26). Infusions had been administered with reused IV drip sets in 70% of cases compared with 8% of controls (aOR = 197, 95% CI: 16 to 2400).
Private physicians reusing intravenous drip sets to treat outpatients seen in private practice were responsible for this HIV epidemic. Mapping and regulation of private practitioners were suggested.
2019 年 4 月至 6 月，巴基斯坦拉尔卡纳共发现 909 例新的 HIV 感染病例，其中 86%为 15 岁以下儿童。为了确定此次疫情的可能传播途径，我们于 2019 年 6 月开展了一项病例对照研究。
对于病例，我们从筛查名单中系统随机选择了 100 例 HIV 阳性儿童。我们从每个 HIV 阳性病例的邻里选择了 2 名年龄和性别匹配的对照。所有入选儿童均采用世界卫生组织批准的快速诊断检测算法进行检测。我们采访了每个选定儿童的父母，了解他们之前是否接受过静脉注射治疗，并使用条件逻辑回归比较病例和对照儿童的暴露情况。
入选儿童的年龄范围为 1 个月至 10 岁。超过 90%的 HIV+和 HIV-儿童都曾接受过 MBBS 合格的私人医生的门诊医疗。83%的 HIV+儿童与 46%的 HIV-儿童曾接受过同一位私人医生的治疗[aOR = 29，95%置信区间（95%CI）：10 至 79]。29%的病例组儿童在最近一次门诊就诊时接受过静脉输液治疗，而 7%的对照组儿童接受过静脉输液治疗[aOR = 57，95%CI：2.9 至 >1000]，而没有病例儿童和 17%的对照儿童仅接受过肌内注射[aOR = 0，95%CI：0 至 41]。在病例组中，94%的儿童使用滴注套件进行输液，而对照组儿童这一比例为 85%[aOR = 7.7，95%CI：2.3 至 26]。70%的病例组儿童使用的是重复使用的静脉滴注套件进行输液，而对照组儿童这一比例为 8%[aOR = 197，95%CI：16 至 2400]。
在私人诊所为门诊就诊的患者重复使用静脉滴注套件的私人医生应对此次 HIV 疫情负责。建议对私人医生进行定位和监管。
