Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Department of Pediatrics, Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
J Acquir Immune Defic Syndr. 2022 Jul 1;90(3):300-308. doi: 10.1097/QAI.0000000000002957.
Although achievements have been made globally since the UNAIDS 90-90-90 targets were announced, paediatric data remain sparse. We describe achievements toward antiretroviral therapy (ART) uptake and viral load (VL) suppression, existing gaps, and potential best practices among children and adolescents living with HIV (CALHIV) across 6 Eastern and Southern African countries.
Baylor College of Medicine International Paediatric AIDS Initiative Network sites in Botswana, Eswatini, Lesotho, Malawi, Tanzania, and Uganda.
We performed retrospective data analysis among CALHIV ages 0-19 years between 2014 and 2019.
A total of 25,370 CALHIV received care, 85.8% (21,773/25,370) received ART, 84.4% (18,376/21,773) had documented VL results, and 74.6% (13,715/18,376) had VL < 1000 cps/mL. By 2019, the pooled proportion of CALHIV receiving ART and having viral suppression increased to 99.8% [95% confidence interval (CI): 98.1 to 100.0] and 89.8% (95 CI: 88.2 to 91.5) respectively. Lower rates of viral suppression and higher lost to follow-up (LTFU) were seen in the 0-4-year and 15-19-year cohorts. CALHIV on ART not achieving viral suppression were younger, received care in Malawi or Mbeya, had a history of tuberculosis, lower rates of integrase-strand inhibitor-based ART, and were on ART for shorter durations. Best practices reported included adopting universal ART, ART optimization with protease inhibitor-based and/or dolutegravir-based regimens, peer-supported activities, child/adolescent friendly services, community-supported activities, and technology-driven quality improvement activities and digital solutions.
High rates of CALHIV receiving ART and having viral suppression can be achieved in settings in Eastern and Southern Africa through using pediatric best practices. Increased efforts must be made to address LTFU and to support under-fives and adolescents.
自联合国艾滋病规划署提出 90-90-90 目标以来，全球在艾滋病防治方面取得了一定成就，但儿科数据仍然匮乏。本研究描述了 6 个东非和南部非洲国家的儿童和青少年艾滋病病毒感染者（CALHIV）在接受抗逆转录病毒治疗（ART）和病毒载量（VL）抑制方面取得的成就、存在的差距以及潜在的最佳实践。
博茨瓦纳、斯威士兰、莱索托、马拉维、坦桑尼亚和乌干达的贝勒医学院国际儿科艾滋病倡议网络（Baylor College of Medicine International Paediatric AIDS Initiative Network）的站点。
我们对 2014 年至 2019 年间年龄在 0 至 19 岁的 CALHIV 进行了回顾性数据分析。
共有 25370 名 CALHIV 接受了治疗，85.8%（21773/25370）接受了 ART，84.4%（18376/21773）有记录的 VL 结果，74.6%（13715/18376）VL<1000 cps/mL。到 2019 年，CALHIV 接受 ART 和病毒抑制的比例分别增加到 99.8%[95%置信区间（CI）：98.1-100.0]和 89.8%（95%CI：88.2-91.5）。0-4 岁和 15-19 岁年龄组的病毒抑制率较低，失访率（LTFU）较高。未达到病毒抑制的接受 ART 的 CALHIV 更年轻，在马拉维和姆贝亚接受治疗，有结核病病史，整合酶抑制剂为基础的 ART 率较低，接受 ART 的时间较短。报告的最佳实践包括采用普遍的 ART、使用蛋白酶抑制剂为基础和/或多替拉韦为基础的方案进行 ART 优化、同伴支持活动、儿童/青少年友好服务、社区支持活动、以技术为驱动的质量改进活动和数字解决方案。
通过采用儿科最佳实践，在东非和南部非洲的环境中可以实现 CALHIV 接受 ART 和病毒抑制的高比例。必须加大努力解决失访问题，并为 0 至 5 岁儿童和青少年提供支持。
