Haw Nel Jason L, Banegas Marcela, Lujintanon Sita, Fairlie Lee, Bwakura-Dangarembizi Mutsa, Agwu Allison, Ng Derek K, Lesko Catherine R
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2025 Jun;28(6):e26526. doi: 10.1002/jia2.26526.
INTRODUCTION: The "Universal Test and Treat" (UTT) era for antiretroviral therapy (ART) increased HIV service delivery to children and adolescents aged 0-19 with HIV. The goal is to reach ≥95% of people with HIV diagnosed, receiving ART and virally suppressed. We conducted a systematic review and meta-analysis to describe the care continuum among children and adolescents with HIV during the UTT era in the UNAIDS eastern and southern African region. METHODS: We searched PubMed, EMBASE and African Index Medicus databases for peer-reviewed articles published from 1 January 2010 to 1 June 2023. We included studies reporting ≥1 care continuum proportion in ≥1 country in the study region during the country's UTT implementation. We extracted summary proportions and pooled them using random-effects logistic regression. RESULTS: Of 10,281 studies screened, 190 met the inclusion criteria. Studies came from 16 countries; many from South Africa (n = 37) and Ethiopia (n = 32). The meta-analysis pooled proportions (95% confidence intervals) for children aged 0-14 were: 72% (60%, 81%) aware of HIV diagnosis; 95% (89%, 97%) on ART among diagnosed; 88% (76%, 95%) retained in HIV care after 12 months on ART; 77% (68%, 84%) self-/caregiver-reported ART adherence; 90% (79%, 95%) had a viral load test after ART initiation; and 76% (72%, 79%) viral suppression (<1000 copies/ml) while on ART with a viral load test. Similar proportions were estimated among adolescents aged 15-19: 73% (66%, 79%) diagnosed; 93% (92%, 94%) on ART; 80% (54%, 93%) retained; 74% (63%, 83%) adherent; 90% (79%, 95%) viral load test; and 78% (74%, 81%) viral suppression. DISCUSSION: Estimates from this study on diagnosis, ART initiation and viral suppression were consistent with UNAIDS official estimates. Estimates on retention, adherence and viral suppression were similar to previous meta-analyses conducted before UTT. CONCLUSIONS: Consistent with UTT expectations, most children and adolescents with HIV in eastern and southern Africa have initiated ART, but challenges remain on other care continuum indicators. Future planning for HIV programmes should consider locally informed, community-supported approaches to consistently support children and adolescents with HIV throughout the HIV care continuum.
引言：抗逆转录病毒疗法（ART）的“普遍检测与治疗”（UTT）时代增加了为0至19岁感染艾滋病毒的儿童和青少年提供的艾滋病毒服务。目标是使≥95%的艾滋病毒感染者得到诊断、接受抗逆转录病毒治疗并实现病毒抑制。我们进行了一项系统评价和荟萃分析，以描述联合国艾滋病规划署东非和南部非洲区域UTT时代艾滋病毒感染儿童和青少年的护理连续体情况。 方法：我们在PubMed、EMBASE和非洲医学索引数据库中搜索了2010年1月1日至2023年6月1日发表的同行评审文章。我们纳入了在研究区域内≥1个国家实施UTT期间报告了≥1个护理连续体比例的研究。我们提取了汇总比例，并使用随机效应逻辑回归进行汇总。 结果：在筛选的10281项研究中，190项符合纳入标准。研究来自16个国家；许多来自南非（n = 37）和埃塞俄比亚（n = 32）。0至14岁儿童的荟萃分析汇总比例（95%置信区间）为：72%（60%，81%）知晓艾滋病毒诊断；确诊者中95%（89%，97%）接受抗逆转录病毒治疗；接受抗逆转录病毒治疗12个月后88%（76%，95%）继续接受艾滋病毒护理；77%（68%，84%）自我/照顾者报告的抗逆转录病毒治疗依从性；90%（79%，95%）在开始抗逆转录病毒治疗后进行了病毒载量检测；接受病毒载量检测且在接受抗逆转录病毒治疗期间76%（72%，79%）实现病毒抑制（<1000拷贝/毫升）。15至19岁青少年的估计比例相似：73%（66%，79%）确诊；93%（92%，94%）接受抗逆转录病毒治疗；80%（54%，93%）继续接受护理；74%（63%，83%）依从；90%（79%，95%）进行病毒载量检测；78%（74%，81%）实现病毒抑制。 讨论：本研究中关于诊断、开始抗逆转录病毒治疗和病毒抑制的估计与联合国艾滋病规划署的官方估计一致。关于继续接受护理、依从性和病毒抑制的估计与UTT之前进行的先前荟萃分析相似。 结论：与UTT的预期一致，东非和南部非洲的大多数感染艾滋病毒的儿童和青少年已经开始接受抗逆转录病毒治疗，但在其他护理连续体指标方面仍存在挑战。未来的艾滋病毒项目规划应考虑采用因地制宜、社区支持的方法，以持续支持感染艾滋病毒的儿童和青少年在整个艾滋病毒护理连续体过程中。
Cochrane Database Syst Rev. 2025-6-16
Cochrane Database Syst Rev. 2025-5-7
Cochrane Database Syst Rev. 2025-6-20
Zotero 插件