我们从哪里来，又要往哪里去？南非约翰内斯堡的儿科艾滋病毒项目，2004 年至 2018 年：项目趋势的回顾性分析。

Where have we come from and where are we going? The paediatric HIV programme in Johannesburg, South Africa, from 2004 to 2018: A retrospective analysis of programme trends.

机构信息

Anova Health Institute, Johannesburg, South Africa; Department of Community Paediatrics, School of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

S Afr Med J. 2022 Apr 30;112(5):328-334.

PMID:35587245

Abstract

BACKGROUND

The paediatric HIV treatment programme in South Africa (SA) has grown since its inception in 2004. Despite this impressive scale-up of antiretroviral therapy (ART) in children, the proportion of children started on ART and retained in care remains unacceptably low, with only 47% of the 340 000 HIV-positive children in SA on ART in 2020. Johannesburg is one of the districts in SA with the largest number of children living with HIV who are not on ART, and is a priority district for paediatric case finding and retention.

OBJECTIVES

To describe the dynamics of the paediatric HIV programme in Johannesburg, SA.

METHODS

A secondary analysis was conducted on patient-level HIV treatment data from TIER.Net, the nationally mandated HIV/ART database. Children aged <15 years who received ART between January 2004 and June 2019 at public health facilities in Johannesburg were included. We reported the number of children on ART and the number who entered and exited the programme by age group over time, and analysed the trends of these indicators.

RESULTS

By December 2018, 7 630 children aged <15 years remained in Johannesburg's paediatric ART programme: 82.5% were aged 5 - <15 years, with 54.1% of these being 10 - <15 years old. During the study period, 19 850 children were newly initiated on ART. New initiations slowed from 2013, to range from 1 172 to 1 373 yearly. In 2018, 34.2% of initiators were aged <1 year, 24.2% 1 - <5 years and 41.6% 5 - <15 years. Despite these initiations, the number of children on ART only grew by 97 in 2018, owing to programme losses. In 2018, 924 children (12.1%) aged out, 35 (0.5%) died and 983 (12.9%) were lost to follow-up (LTFU), the latter having increased from 10.7% in 2017. Of children who aged out of the paediatric ART programme, 56.3% remained in care at the same facility.

CONCLUSION

Early in the SA ART roll-out, many children were found to be HIV infected and started on ART. This number started to slow in 2013, after which the growth rate of the paediatric HIV programme also began to slow. Scale-up of methods for identifying older children with HIV is needed. While ageing out of the paediatric programme is a consideration, the number of children LTFU remains unacceptably high. Further interrogation of barriers to paediatric retention is needed to help realise the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90:90:90 goals for children in SA.

摘要

背景

南非（SA）的儿科艾滋病毒治疗方案自 2004 年成立以来不断发展。尽管儿童抗逆转录病毒治疗（ART）的规模显著扩大，但开始接受 ART 治疗和留在护理中的儿童比例仍然低得令人无法接受，2020 年，仅 34 万名 HIV 阳性儿童中的 47%接受了 ART 治疗。约翰内斯堡是南非未接受 ART 治疗的 HIV 阳性儿童人数最多的地区之一，也是儿科病例发现和保留的重点地区。

目的

描述南非约翰内斯堡儿科艾滋病毒方案的动态。

方法

对 TIER.Net（国家规定的 HIV/ART 数据库）中的患者级艾滋病毒治疗数据进行二次分析。该研究纳入了 2004 年 1 月至 2019 年 6 月期间在约翰内斯堡公立卫生机构接受 ART 治疗的年龄 <15 岁的儿童。我们按年龄组报告了接受 ART 治疗的儿童人数和进入和退出方案的人数，并分析了这些指标的趋势。

结果

截至 2018 年 12 月，7630 名年龄 <15 岁的儿童仍留在约翰内斯堡的儿科 ART 方案中：82.5%的儿童年龄为 5- <15 岁，其中 54.1%为 10- <15 岁。在研究期间，有 19850 名儿童新开始接受 ART 治疗。新启动人数从 2013 年开始放缓，每年范围为 1721-1373 人。2018 年，34.2%的新启动者年龄 <1 岁，24.2%的新启动者年龄为 1- <5 岁，41.6%的新启动者年龄为 5- <15 岁。尽管有这些新启动者，但 2018 年接受 ART 治疗的儿童人数仅增加了 97 人，原因是方案损失。2018 年，有 924 名儿童（12.1%）年龄超过，35 名儿童（0.5%）死亡，983 名儿童（12.9%）失访（LTFU），后者从 2017 年的 10.7%上升。在退出儿科 ART 方案的儿童中，56.3%仍在同一机构接受护理。

结论

在南非抗逆转录病毒治疗的早期，发现许多儿童感染了 HIV 并开始接受 ART 治疗。自 2013 年以来，这一数字开始放缓，此后，儿科艾滋病毒方案的增长率也开始放缓。需要扩大方法来识别年龄较大的 HIV 感染儿童。虽然从儿科方案中毕业是一个考虑因素，但失访儿童的数量仍然高得令人无法接受。需要进一步调查儿科保留的障碍，以帮助实现联合国艾滋病规划署（UNAIDS）在南非为儿童制定的 90:90:90 目标。