Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
Instituto Nacional de Saúde, Ministério de Saúde (INS), Maputo, Mozambique.
PLoS One. 2021 Dec 16;16(12):e0261356. doi: 10.1371/journal.pone.0261356. eCollection 2021.
Manhiça District, in Southern Mozambique harbors high HIV prevalence and a long history of migration. To optimize HIV care, we sought to assess how caregiver's mobility impacts children living with HIV (CLHIV)´s continuation in HIV care and to explore the strategies used by caregivers to maintain their CLHIV on antiretroviral treatment (ART).
A clinic-based cross-sectional survey conducted at the Manhiça District Hospital between December-2017 and February-2018. We enrolled CLHIV with a self-identified migrant caregiver (moved outside of Manhiça District ≤12 months prior to survey) and non-migrant caregiver, matched by the child age and sex. Survey data were linked to CLHIV clinical records from the HIV care and treatment program.
Among the 975 CLHIV screened, 285 (29.2%) were excluded due to absence of an adult at the appointment. A total of 232 CLHIV-caregiver pairs were included. Of the 41 (35%) CLHIV migrating with their caregivers, 38 (92.6%) had access to ART at the destination because either the caregivers travelled with it 24 (63%) or it was sent by a family member 14 (36%). Among the 76 (65%) CLHIV who did not migrate with their caregivers, for the purpose of pharmacy visits, 39% were cared by their grandfather/grandmother, 28% by an aunt/uncle and 16% by an adult brother/sister. CLHIV of migrant caregivers had a non-statistically significant increase in the number of previous reported sickness episodes (OR = 1.38, 95%CI: 0.79-2.42; p = 0.257), ART interruptions (OR = 1.73; 95%CI: 0.82-3.63; p = 0.142) and lost-to-follow-up episodes (OR = 1.53; 95%CI: 0.80-2.94; p = 0.193).
Nearly one third of the children attend their HIV care appointments unaccompanied by an adult. The caregiver mobility was not found to significantly affect child's retention on ART. Migrant caregivers adopted strategies such as the transportation of ART to the mobility destination to avoid impact of mobility on the child's HIV care. However this may have implications on ART stability and effectiveness that should be investigated in rural areas.
莫桑比克南部的马希奇区艾滋病毒感染率居高不下，且存在长期的人口迁移情况。为了优化艾滋病毒护理，我们评估了看护者的流动如何影响感染艾滋病毒的儿童（CLHIV）继续接受艾滋病毒护理，并探讨了看护者在维持接受抗逆转录病毒治疗（ART）的 CLHIV 方面所采用的策略。
这是一项在马希奇区医院进行的基于诊所的横断面调查，时间为 2017 年 12 月至 2018 年 2 月。我们招募了有自我认同的流动人口看护者（在调查前 12 个月内搬离马希奇区）的 CLHIV ，以及非流动人口看护者，根据儿童的年龄和性别进行匹配。调查数据与艾滋病毒护理和治疗方案中的 CLHIV 临床记录相关联。
在接受筛查的 975 名 CLHIV 中，有 285 名（29.2%）因预约时没有成年人在场而被排除在外。共纳入 232 对 CLHIV-看护者。在与看护者一起迁移的 41 名（35%）CLHIV 中，38 名（92.6%）能够在目的地获得 ART，因为看护者 24 名（63%）携带它或有家庭成员 14 名（36%）将其寄来。在没有与看护者一起迁移的 76 名（65%）CLHIV 中，有 39%由他们的祖父/祖母、28%由阿姨/叔叔、16%由成年兄弟姐妹照顾，目的是去药店就诊。与流动人口看护者的 CLHIV 相比，之前报告的疾病发作次数（比值比=1.38，95%CI：0.79-2.42；p=0.257）、ART 中断次数（比值比=1.73；95%CI：0.82-3.63；p=0.142）和失访次数（比值比=1.53；95%CI：0.80-2.94；p=0.193）没有统计学意义上的增加。
近三分之一的儿童在没有成年人陪同的情况下参加艾滋病毒护理预约。看护者的流动并未显著影响儿童接受 ART 的保留率。流动人口看护者采取了一些策略，如将 ART 运送到流动目的地，以避免流动对儿童艾滋病毒护理的影响。然而，这可能会对农村地区的 ART 稳定性和有效性产生影响，需要进行调查。
