Long-term impact of the Kenya postelection crisis on clinic attendance and medication adherence for HIV-infected children in western Kenya.
Long-term impact of the Kenya postelection crisis on clinic attendance and medication adherence for HIV-infected children in western Kenya.
复制标题
肯尼亚选举后危机对肯尼亚西部艾滋病毒感染儿童的就诊和用药依从性的长期影响。
DOI：
10.1097/qai.0b013e31823b4448
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Wiehe,SarahE
中科院分区：
文献类型：
--
作者：
Yoder,RachelB;Nyandiko,WinstoneM;Vreeman,RachelC;Ayaya,SamwelO;Gisore,PeterO;Braitstein,Paula;Wiehe,SarahE
背景：肯尼亚在 2007 年 12 月 27 日总统选举后经历了一场政治和人道主义危机。我们试图描述这场冲突对肯尼亚西部艾滋病毒感染儿童的直接和长期影响。方法：我们对这些儿童的队列进行了 3 个时期的回顾性研究：第 1 时期，选举前（2007 年 10 月 26 日至 2007 年 12 月 25 日）；第二阶段，选举后（2007年12月26日至2008年4月15日）；第三阶段，长期选举后（2008年4月16日至2008年12月31日）。评估了失访 (LTFU) 的两个结果变量：初始 LTFU 和完全 LTFU。我们通过评估实际就诊和预期就诊之间的差异来评估诊所依从性。在接受抗逆转录病毒治疗 (ART) 的儿童中，我们评估了总体药物依从性和药物依从性的变化。结果：第 1 阶段观察到了 2549 名 14 岁以下的 HIV 感染儿童。接受 ART 的儿童的初始 LTFU 较低（3.0% 与 5.1% 相比，P< 0.01），且完全 LTFU 较低（2.6% 与 6.8% 相比，P< 0.001）。未接受 ART 治疗的儿童。对于未接受 ART 的儿童，与第 2 期相比，第 3 期的临床依从性有所提高。对于采用更严格的临床依从性衡量标准的 ART 儿童，临床依从性随着时间的推移而下降。孤儿比非孤儿具有更好的临床依从性。在接受 ART 的儿童中，在比较不同时间的药物依从性时，几乎没有人口统计学差异。结论：艾滋病毒感染儿童在人道主义危机后面临临床随访和药物依从性中断的风险。个人和环境因素会减轻这些破坏的影响。 背景 非洲是世界上武装冲突发生率最高的国家，2007 年，近四分之一的非洲国家经历了冲突。1 武装冲突地区的个人和家庭面临着严重和长期的健康风险，包括伤害、离散、粮食不安全和获得医疗保健的机会减少。许多人因恐惧或暴力而流离失所，必须住在难民/境内流离失所者的临时房屋或营地，在那里他们面临更大的风险，例如感染、营养不良和粮食不安全。 2-4 儿童在危机中特别脆弱，被遗弃、绑架、营养不良和传染病的风险增加。 4
Background:Kenya experienced a political and humanitarian crisis after presidential elections on December 27, 2007. We sought to describe both the immediate and long-term impact of this conflict for HIV-infected children in western Kenya.Methods:We conducted a retrospective study of a cohort of these children for 3 periods: period 1, before the election (October 26, 2007, to December 25, 2007); period 2, immediately after the election (December 26, 2007, to April 15, 2008); and period 3, long-term postelection (April 16, 2008, to December 31, 2008). Two outcome variables of loss-to-follow-up (LTFU) were assessed: initial LTFU and complete LTFU. We assessed clinic adherence by evaluating the difference between actual visits and expected visits. Among children on antiretroviral therapy (ART), we assessed overall medication adherence and changes in medication adherence.Results:Two thousand five hundred forty-nine HIV-infected children< 14 years were seen in period 1. Children on ART had less initial LTFU (3.0% compared with 5.1%, P< 0.01) and less complete LTFU (2.6% compared with 6.8%, P< 0.001) than children not on ART. For children not on ART, clinic adherence improved in period 3 compared with period 2. For children on ART with a more strict measure of clinic adherence, clinic adherence declined over time. Orphans had better clinic adherence than nonorphans. Among children on ART, there were few demographic differences when comparing medication adherence between time.Conclusions:HIV-infected children are at risk for disruptions in clinic follow-up and medication adherence after a humanitarian crisis. Individual and contextual factors moderate the effects of these disruptions.BACKGROUNDAfrica has the world's highest rate of armed conflict, with nearly 1 quarter of African countries experiencing conflict in 2007. 1 Individuals and families in regions of armed conflict face both acute and long-term risks to health, including injury, separation, food insecurity, and decreased access to health care. Many are displaced from their homes by fear or violence and must live in makeshift homes or camps for refugees/internally displaced people, where they face increased risks, such as infection, malnutrition, and food insecurity. 2–4 Children are particularly vulnerable in crises and are at increased risk of abandonment, abduction, malnutrition, and communicable diseases. 4