HIV infection among children and adolescents in Burundi, Cameroon, and the Democratic Republic of Congo.
HIV infection among children and adolescents in Burundi, Cameroon, and the Democratic Republic of Congo.
复制标题
布隆迪、喀麦隆和刚果民主共和国儿童和青少年的艾滋病毒感染情况。
DOI：
10.1080/09540121.2016.1273472
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发表时间：
2017
期刊：
影响因子：
1.7
通讯作者：
Hemingway-Foday,J
中科院分区：
文献类型：
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作者：
NapieralaMavedzenge,Sue;Newman,JamieE;Nduwimana,Martin;Bukuru,Helene;Kariyo,Pierre;Niyongabo,Théodore;Mbaya,Marcel;Mukumbi,Henri;Kamgaing,Nelly;Obama,Marie-Thérèse;Akam,Wilfred;Atibu,Joseph;Kiumbu,Modeste;Hemingway-Foday,J
有证据表明，在艾滋病毒长期普遍流行的国家，艾滋病毒在儿童和青少年中大量流行，在这些国家，预防母婴传播服务的提供历来有限。这项研究的目的是探索与抗逆转录病毒疗法(ART)启动相关的因素，以及在参加中部非洲艾滋病毒项目的2-17岁幸存艾滋病毒儿童中的发病率。我们的评估包括布隆迪、喀麦隆和刚果民主共和国(DRC)404名参加艾滋病毒项目的儿童的方案数据。根据每个诊所的护理标准，从2008年到2011年对儿童进行了前瞻性跟踪调查。参考医院的诊断与未启动抗逆转录病毒治疗显著相关(调整后的优势比，AOR = 为0.40；95%可信区间，CI为0.24-0.67)。在喀麦隆的诊所就诊(AOR = 0.45；95%CI = 0.24-0.85)和上学与降低风险相关(AOR = 0.55；95%CI = 0.31-0.96)。天真(AOR = 1.88；95%CI = 1.20-2.94)和在参考医院(AOR = 2.39；95%CI = 1.29-4.41)或其他检测机构(AOR = 2.86；95%CI = 1.32-6.18)诊断与初次就诊时发生病态事件的风险增加相关。在对事件发病率的纵向分析中，我们发现在喀麦隆(调整后的危险比，AHR = 0.23；95%CI = 0.11-0.46)和刚果民主共和国(AHR = 0.46；95%CI = 0.29-0.74)就诊的风险降低，而与天真的艺术(AHR = 1.83；95%CI = 1.12-2.97)相关的风险增加。我们发现，在这种环境下接受护理的儿童中，艾滋病毒相关健康问题的负担很重。儿童在获得艾滋病毒服务方面面临重大障碍，中部非洲区域幸存儿童中的艾滋病毒流行病没有得到充分评估或解决。
Evidence demonstrates a substantial HIV epidemic among children and adolescents in countries with long-standing generalized HIV epidemics, where availability of prevention of mother-to-child transmission services has historically been limited. The objective of this research was to explore factors associated with antiretroviral therapy (ART) initiation and morbidity among HIV-infected surviving children 2–17 years of age attending HIV programs in Central Africa. Programmatic data from 404 children attending HIV programs in Burundi, Cameroon, and the Democratic Republic of Congo (DRC) were included in our evaluation. Children were followed prospectively from 2008 to 2011 according to each clinic’s standard of care. Diagnosis at a reference hospital was significantly associated with not having initiated ART (adjusted odds ratio, AOR = 0.40; 95% confidence interval, CI, 0.24–0.67). Being seen at a clinic in Cameroon (AOR = 0.45; 95%CI = 0.24–0.85) and being in school were associated with decreased risk (AOR = 0.55; 95%CI = 0.31–0.96). Being ART-naïve (AOR = 1.88; 95%CI = 1.20–2.94) and being diagnosed at a reference hospital (AOR = 2.39; 95%CI = 1.29–4.41) or other testing facility (AOR = 2.86; 95%CI = 1.32–6.18) were associated with increased risk of having a morbid event at the initial visit. In longitudinal analysis of incident morbidity, we found a decreased risk associated with attending clinics in Cameroon (adjusted hazard ratio, AHR = 0.23; 95%CI = 0.11–0.46) and the DRC (AHR = 0.46; 95%CI = 0.29–0.74), and an increased risk associated with being ART-naïve (AHR = 1.83; 95%CI = 1.12–2.97). We found a high burden of HIV-related health problems among children receiving care in this setting. Children face significant barriers to accessing HIV services, and the HIV epidemic among surviving children in the Central African region has not been adequately evaluated nor addressed.