在埃塞俄比亚，新诊断出 HIV 感染的儿童中，确认性 HIV 检测、与 HIV 服务的衔接以及抗逆转录病毒治疗的快速启动率：照顾者和医疗保健工作者的观点。
Rates of confirmatory HIV testing, linkage to HIV services, and rapid initiation of antiretroviral treatment among newly diagnosed children living with HIV in Ethiopia: perspectives from caregivers and healthcare workers.
机构信息
Ethiopian Public Health Association, Addis Ababa, Ethiopia.
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
出版信息
BMC Pediatr. 2022 Dec 26;22(1):736. doi: 10.1186/s12887-022-03784-3.
BACKGROUND
Successful linkage to HIV services and initiation of antiretroviral treatment (ART) for children living with HIV (CLHIV) is critical to improve pediatric ART coverage. We aimed to assess confirmatory testing, linkage, and rapid ART initiation among newly diagnosed CLHIV in Ethiopia from the perspectives of caregivers and healthcare workers (HCWs).
METHODS
We conducted standardized surveys with HCWs and caregivers of children 2-14 years who were diagnosed with HIV but not yet on ART who had been identified during a cross-sectional study in Ethiopia from May 2017-March 2018. Eight health facilities based on their HIV caseload and testing volume and 21 extension sites were included. Forty-one children, 34 care givers and 40 healthcare workers were included in this study. Three months after study enrollment, caregivers were surveyed about timing and experiences with HIV service enrollment, confirmatory testing, and ART initiation. Data collected from HCWs included perceptions of confirmatory testing in CLHIV before ART initiation. SPSS was used to conduct descriptive statistics.
RESULTS
The majority of the 41 CLHIV were enrolled to HIV services (n = 34, 83%) and initiated ART by three months (n = 32, 94%). Median time from diagnosis to ART initiation was 12 days (interquartile range 5-18). Five children died before the follow-up interview. Confirmatory HIV testing was conducted in 34 children and found no discordant results; the majority (n = 23, 68%) received it within one week of HIV diagnosis. Almost all HCWs (n = 39/40, 98%) and caregivers (n = 31/34, 91%) felt better/the same about test results after conducting confirmatory testing.
CONCLUSION
Opportunities remain to strengthen linkage for newly diagnosed CLHIV in Ethiopia through intensifying early follow-up to ensure prompt confirmatory testing and rapid ART initiation. Additional services could help caregivers with decision-making around treatment initiation for their children.
背景
对于感染艾滋病毒的儿童（CLHIV）而言，成功将其链接到艾滋病毒服务并开始接受抗逆转录病毒治疗（ART），对于提高儿科 ART 覆盖率至关重要。我们旨在从护理人员和医疗保健工作者（HCWs）的角度评估新诊断出的 CLHIV 的确认性检测、链接和快速开始 ART。
方法
我们对埃塞俄比亚的 HCWs 和儿童（2-14 岁）的护理人员进行了标准化调查，这些儿童在 2017 年 5 月至 2018 年 3 月期间的横断面研究中被诊断出 HIV 但尚未接受 ART。共纳入了 8 家基于 HIV 病例数和检测量的卫生机构和 21 个扩展站点。本研究共纳入 41 名儿童、34 名照顾者和 40 名医疗保健工作者。在研究入组后三个月，对照顾者进行了关于 HIV 服务入组、确认性检测和 ART 启动的时间和经验的调查。从 HCWs 收集的数据包括在开始 ART 之前对 CLHIV 进行确认性检测的看法。使用 SPSS 进行描述性统计。
结果
大多数新诊断出的 41 名 CLHIV 已入组接受 HIV 服务（n=34，83%），并在三个月内开始接受 ART（n=32，94%）。从诊断到开始 ART 的中位时间为 12 天（四分位距 5-18）。有 5 名儿童在随访前死亡。对 34 名儿童进行了确认性 HIV 检测，未发现不一致的结果；大多数（n=23，68%）在 HIV 诊断后一周内进行了检测。几乎所有 HCWs（n=39/40，98%）和照顾者（n=31/34，91%）在进行确认性检测后对检测结果感觉更好/相同。
结论
埃塞俄比亚新诊断出的 CLHIV 仍有机会通过加强早期随访来加强链接，以确保及时进行确认性检测和快速开始 ART。可以提供更多的服务，帮助照顾者在决定为其子女开始治疗时做出决策。
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