Systems Analysis and Improvement Approach to optimize the pediatric and adolescent HIV Cascade (SAIA-PEDS): a pilot study.
Systems Analysis and Improvement Approach to optimize the pediatric and adolescent HIV Cascade (SAIA-PEDS): a pilot study.
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DOI：
10.1186/s43058-022-00272-8
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发表时间：
2022-05-10
影响因子：
--
通讯作者：
Sherr, Kenneth
中科院分区：
文献类型：
--
作者：
Wagner, Anjuli D.;Augusto, Orvalho;Njuguna, Irene N.;Gaitho, Douglas;Mburu, Nancy;Oluoch, Geoffrey;Carimo, Naziat;Mwaura, Peter;Cherutich, Peter;Oyiengo, Laura;Gimbel, Sarah;John-Stewart, Grace C.;Nduati, Ruth;Sherr, Kenneth
关键词：
儿童和青少年在实现联合国艾滋病规划署 95-95-95 艾滋病毒检测、治疗和病毒抑制目标方面落后于成年人。系统分析和改进方法 (SAIA) 是一项多组成部分的实施策略，之前已证明可以改善孕妇和婴儿的艾滋病毒护理级联。 SAIA 值得进行调整和测试，以缩小儿科和青少年艾滋病毒连锁反应的差距。我们调整了 SAIA 战略组成部分，使其适用于内罗毕和肯尼亚西部的儿科和青少年艾滋病毒护理级联 (SAIA-PEDS)。我们在 5 个机构测试了 SAIA-PEDS 策略是否改善了 0-24 岁儿童和青少年的 HIV 检测、与护理的联系、抗逆转录病毒治疗 (ART)、病毒载量 (VL) 检测以及病毒载量抑制。我们使用抽象的常规程序数据对实施前 6 个月和实施后 6 个月的策略（加上中断时间序列敏感性分析）进行了前后分析，以确定 SAIA-PEDS 引起的变化。不同机构之间的艾滋病毒检测和护理级联指标的基线水平存在差异。每个机构每月平均有 842 名接受艾滋病毒检测的门诊和住院儿童/青少年；平均而言，253 人接受了艾滋病毒检测服务，6 人检测呈阳性，6 人接受护理，5 人开始接受抗逆转录病毒治疗。在该机构接受治疗的人中，平均有 15 人采集了 VL 样本，13 人返回了抑制的 VL 结果。 SAIA-PEDS 培训和指导后，HIV 检测比率（RR：0.803 [95% CI：0.420，1.532]）和与护理的联系（RR：0.831 [95% CI：0.546，1.266]）没有实质性或显着变化。开始 ART 的比例大幅增加并趋于显着（RR：1.412 [95% CI：0.999，1.996]）。订购 VL 测试的比例有显着且实质性的改善（RR：1.939 [95% CI：1.230，3.055]），但 VL 结果被抑制的比例没有实质性或显着变化（RR：0.851 [95% CI：0.554，1.306]）。试点的 SAIA-PEDS 实施战略与艾滋病毒护理级联后期指标的卫生系统绩效提高有关，但与艾滋病毒检测和治疗指标无关。该策略值得进一步严格测试其有效性和持续性。
Children and adolescents lag behind adults in achieving UNAIDS 95-95-95 targets for HIV testing, treatment, and viral suppression. The Systems Analysis and Improvement Approach (SAIA) is a multi-component implementation strategy previously shown to improve the HIV care cascade for pregnant women and infants. SAIA merits adaptation and testing to reduce gaps in the pediatric and adolescent HIV cascade. We adapted the SAIA strategy components to be applicable to the pediatric and adolescent HIV care cascade (SAIA-PEDS) in Nairobi and western Kenya. We tested whether this SAIA-PEDS strategy improved HIV testing, linkage to care, antiretroviral treatment (ART), viral load (VL) testing, and viral load suppression for children and adolescents ages 0–24 years at 5 facilities. We conducted a pre-post analysis with 6 months pre- and 6 months post-implementation strategy (coupled with an interrupted time series sensitivity analysis) using abstracted routine program data to determine changes attributable to SAIA-PEDS. Baseline levels of HIV testing and care cascade indicators were heterogeneous between facilities. Per facility, the monthly average number of children/adolescents attending outpatient and inpatient services eligible for HIV testing was 842; on average, 253 received HIV testing services, 6 tested positive, 6 were linked to care, and 5 initiated ART. Among those on treatment at the facility, an average of 15 had a VL sample taken and 13 had suppressed VL results returned. Following the SAIA-PEDS training and mentorship, there was no substantial or significant change in the ratio of HIV testing (RR: 0.803 [95% CI: 0.420, 1.532]) and linkage to care (RR: 0.831 [95% CI: 0.546, 1.266]). The ratio of ART initiation increased substantially and trended towards significance (RR: 1.412 [95% CI: 0.999, 1.996]). There were significant and substantial improvements in the ratio of VL tests ordered (RR: 1.939 [95% CI: 1.230, 3.055]) but no substantial or significant change in the ratio of VL results suppressed (RR: 0.851 [95% CI: 0.554, 1.306]). The piloted SAIA-PEDS implementation strategy was associated with increases in health system performance for indicators later in the HIV care cascade, but not for HIV testing and treatment indicators. This strategy merits further rigorous testing for effectiveness and sustainment.
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影响因子：
3.2
作者：
Fabian, Katrin E.;Muanido, Alberto;Wagenaar, Bradley H.
通讯作者：
Wagenaar, Bradley H.
影响因子：
6
作者：
Kim MH;Mazenga AC;Yu X;Ahmed S;Paul ME;Kazembe PN;Abrams EJ
通讯作者：
Abrams EJ
DOI：
10.1097/qai.0000000000001023
发表时间：
2016-07-01
影响因子：
3.6
作者：
Rustagi, Alison Silvis;Gimbel, Sarah;Sherr, Kenneth
通讯作者：
Sherr, Kenneth
影响因子：
8.1
作者：
Adam, Mary Beth;Muma, Sarah;Hansen, Erik N.
通讯作者：
Hansen, Erik N.
影响因子：
2.8
作者：
Kaguthi, Grace Kiringa;Nduba, Videlis;Adam, Mary Beth
通讯作者：
Adam, Mary Beth