Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York, USA
Department of Biostatistics and Health Data Science, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, Indiana, USA.
BMJ Open. 2023 Mar 13;13(3):e069399. doi: 10.1136/bmjopen-2022-069399.
To assess access children with HIV have to comprehensive HIV care services, to longitudinally evaluate the implementation and scale-up of services, and to use site services and clinical cohort data to explore whether access to these services influences retention in care.
A cross-sectional standardised survey was completed in 2014-2015 by sites providing paediatric HIV care across regions of the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We developed a comprehensiveness score based on the WHO's nine categories of essential services to categorise sites as 'low' (0-5), 'medium', (6-7) or 'high' (8-9). When available, comprehensiveness scores were compared with scores from a 2009 survey. We used patient-level data with site services to investigate the relationship between the comprehensiveness of services and retention.
Survey data from 174 IeDEA sites in 32 countries were analysed. Of the WHO essential services, sites were most likely to offer antiretroviral therapy (ART) provision and counselling (n=173; 99%), co-trimoxazole prophylaxis (168; 97%), prevention of perinatal transmission services (167; 96%), outreach for patient engagement and follow-up (166; 95%), CD4 cell count testing (126; 88%), tuberculosis screening (151; 87%) and select immunisation services (126; 72%). Sites were less likely to offer nutrition/food support (97; 56%), viral load testing (99; 69%) and HIV counselling and testing (69; 40%). 10% of sites rated 'low', 59% 'medium' and 31% 'high' in the comprehensiveness score. The mean comprehensiveness of services score increased significantly from 5.6 in 2009 to 7.3 in 2014 (p<0.001; n=30). Patient-level analysis of lost to follow-up after ART initiation estimated the hazard was highest in sites rated 'low' and lowest in sites rated 'high'.
This global assessment suggests the potential care impact of scaling-up and sustaining comprehensive paediatric HIV services. Meeting recommendations for comprehensive HIV services should remain a global priority.
评估感染艾滋病毒的儿童获得综合艾滋病毒护理服务的情况，对服务的实施和扩大进行纵向评估，并利用现场服务和临床队列数据来探讨获得这些服务是否会影响患者的治疗保留率。
2014 年至 2015 年，在国际艾滋病流行病学数据资料库以评价艾滋病（IeDEA）联合会的各区域，通过提供儿科艾滋病毒护理的各个站点进行了一项横断面标准化调查。我们根据世界卫生组织（WHO）的九项基本服务类别制定了一项综合评分，将站点分为“低”（0-5）、“中”（6-7）或“高”（8-9）。当可用时，将综合评分与 2009 年调查的评分进行比较。我们使用具有站点服务的患者水平数据来研究服务的综合性与保留之间的关系。
对来自 32 个国家的 174 个 IeDEA 站点的调查数据进行了分析。在世界卫生组织的基本服务中，站点最有可能提供抗逆转录病毒治疗（ART）供应和咨询（n=173；99%）、复方磺胺甲噁唑预防（168；97%）、预防围产期传播服务（167；96%）、患者参与和随访的外展服务（166；95%）、CD4 细胞计数检测（126；88%）、结核病筛查（151；87%）和选择免疫接种服务（126；72%）。站点不太可能提供营养/食物支持（97；56%）、病毒载量检测（99；69%）和艾滋病毒咨询和检测（69；40%）。10%的站点评分为“低”，59%的站点评分为“中”，31%的站点评分为“高”。服务综合评分从 2009 年的 5.6 显著增加到 2014 年的 7.3（p<0.001；n=30）。在启动抗逆转录病毒治疗后，从治疗中丢失的患者的风险分析估计，评分“低”的站点风险最高，评分“高”的站点风险最低。
这项全球评估表明，扩大和维持全面的儿科艾滋病毒护理服务具有潜在的护理影响。满足全面艾滋病毒服务的建议应继续成为全球优先事项。
