General Medicine, Nakfa Hospital, Ministry of Health Northern Red Sea Branch, Nakfa, Eritrea
Medicine, Orota School of Medicine and Dentistry, Asmara, Eritrea.
BMJ Paediatr Open. 2022 Jul;6(1). doi: 10.1136/bmjpo-2022-001414.
Reducing attrition in paediatric HIV-positive patients using combined antiretroviral therapy (cART) programmes in sub-Saharan Africa is a challenge. This study explored the rates and predictors of attrition in children started on cART in Asmara, Eritrea.
This was a retrospective cohort study using data from all paediatric patients on cART between 2005 and 2020, conducted at the Orotta National Referral and Teaching Hospital. Kaplan-Meier estimates of the likelihood of attrition and multivariate Cox proportional hazards models were used to assess the factors associated with attrition. All p values were two sided and p<0.05 was considered statistically significant.
The study enrolled 710 participants with 374 boys (52.7%) and 336 girls (47.3%). After 5364 person-years' (PY) follow-up, attrition occurred in 172 (24.2%) patients: 65 (9.2%) died and 107 (15.1%) were lost to follow-up (LTFU). The crude incidence rate of attrition was 3.2 events/100 PY, mortality rate was 2.7/100 PY and LTFU was 1.2/100 PY. The independent predictors of attrition included male sex (adjusted HR (AHR)=1.6, 95% CI: 1 to 2.4), residence outside Zoba Maekel (AHR=1.5, 95% CI: 1 to 2.3), later enrolment years (2010-2015: AHR=3.2, 95% CI: 1.9 to 5.3; >2015: AHR=6.1, 95% CI: 3 to 12.2), WHO body mass index-for-age z-score <-2 (AHR=1.4, 95% CI: 0.9 to 2.1), advanced HIV disease (WHO III or IV) at enrolment (AHR=2.2, 95% CI: 1.2 to 3.9), and initiation of zidovudine+lamivudine or other cART backbones (unadjusted HR (UHR)=2, 95% CI: 1.2 to 3.2). In contrast, a reduced likelihood of attrition was observed in children with a record of cART changes (UHR=0.2, 95% CI: 0.15 to 0.4).
A low incidence of attrition was observed in this study. However, the high mortality rate in the first 24 months of treatment and late presentation are concerning. Therefore, data-driven interventions for improving programme quality and outcomes should be prioritised.
在撒哈拉以南非洲地区，使用联合抗逆转录病毒疗法（cART）方案减少儿科 HIV 阳性患者的流失率是一个挑战。本研究旨在探讨厄立特里亚阿斯马拉开始接受 cART 的儿童的流失率及其预测因素。
这是一项回顾性队列研究，使用了 2005 年至 2020 年间所有接受 cART 的儿科患者的数据，在奥罗塔国家转诊和教学医院进行。使用 Kaplan-Meier 估计法评估流失的可能性，并使用多变量 Cox 比例风险模型评估与流失相关的因素。所有 p 值均为双侧，p<0.05 被认为具有统计学意义。
该研究共纳入 710 名参与者，其中 374 名男孩（52.7%）和 336 名女孩（47.3%）。经过 5364 人年的随访，172 名（24.2%）患者发生流失：65 名（9.2%）死亡，107 名（15.1%）失访（LTFU）。流失的粗发生率为 3.2 例/100 人年，死亡率为 2.7/100 人年，LTFU 为 1.2/100 人年。流失的独立预测因素包括男性（调整后的 HR（AHR）=1.6，95%CI：1 至 2.4）、居住地不在马卡勒州（AHR=1.5，95%CI：1 至 2.3）、较晚的登记年份（2010-2015 年：AHR=3.2，95%CI：1.9 至 5.3；>2015 年：AHR=6.1，95%CI：3 至 12.2）、世界卫生组织体重指数年龄 Z 评分<-2（AHR=1.4，95%CI：0.9 至 2.1）、登记时 HIV 疾病较严重（世界卫生组织 III 或 IV 期）（AHR=2.2，95%CI：1.2 至 3.9）以及开始使用齐多夫定+拉米夫定或其他 cART 骨干药物（未调整的 HR（UHR）=2，95%CI：1.2 至 3.2）。相比之下，有 cART 更改记录的儿童发生流失的可能性较低（UHR=0.2，95%CI：0.15 至 0.4）。
本研究观察到流失率较低，但治疗的前 24 个月死亡率较高和就诊较晚令人担忧。因此，应优先考虑针对提高方案质量和结果的数据驱动干预措施。
