Hospital admissions from a pediatric HIV care and treatment program in Malawi.
Hospital admissions from a pediatric HIV care and treatment program in Malawi.
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DOI：
10.1186/s12887-016-0556-3
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发表时间：
2016-01-30
期刊：
影响因子：
2.4
通讯作者：
Kazembe PN
中科院分区：
文献类型：
--
作者：
Nosek CA;Buck WC;Caviness AC;Foust A;Nyondo Y;Bottomani M;Kazembe PN
过去十年来，撒哈拉以南非洲地区儿科抗逆转录病毒治疗项目的规模不断扩大，使越来越多的儿童接受了艾滋病毒治疗。这一患者群体需要终身护理提出了新的挑战，在门诊和住院设置。我们试图描述一家大型儿童艾滋病治疗机构的住院情况，以更好地了解情况的范围，并确定需要改进护理服务的领域。我们对2004年10月至2010年10月在马拉维贝勒医学院儿童基金会登记的所有18岁以下艾滋病毒感染和暴露患者进行了回顾性病例系列研究。纳入当天或之后入院的患者。数据从电子门诊记录中提取。分析是在患者和入院水平上进行的，因为一些患者多次入院。在5062例纳入治疗的患者中，877例（17.3%）在中位年龄24个月时有1137例入院（IQR: 12-62）。191例（21.8%）患者多次入院。入院比例较高的患者为2岁以下（49.4%）、临床登记1个月内（32.9%）、严重免疫抑制（44.0%）和未接受抗逆转录病毒治疗（48.5%）的患者。在这些相同的变量中，初次入院诊断的频率各不相同，营养不良、肺炎和疟疾是最常见的。需要住院治疗的疾病在感染艾滋病毒和接触艾滋病毒的儿童中很常见，这些结果加强了对综合护理方案的需要，特别注意营养。还需要加强疟疾预防规划和扩大肺炎球菌疫苗的可及性。24个月以下的儿童和那些新登记的儿童入院的高负担表明，需要继续改善早期婴儿诊断和提供者发起的测试项目，以便在症状出现之前将患者与护理联系起来。同样，尚未开始抗逆转录病毒治疗的儿童入院比例很高，这强调了对符合条件的儿科患者迅速开始抗逆转录病毒治疗的重要性。
The scale up of pediatric antiretroviral treatment programs across Sub-Saharan Africa over the last decade has brought increasing numbers of children into HIV care. This patient population requiring life-long care presents new challenges in the outpatient and inpatient settings. We sought to describe hospitalizations from a large pediatric HIV treatment facility to better understand the scope of the situation and identify areas for improved care delivery. We conducted a retrospective case series of all HIV-infected and exposed patients <18 years enrolled at Baylor College of Medicine Children’s Foundation Malawi, from October 2004-October 2010. Patients admitted to the hospital on or after the day of enrollment were included. Data were extracted from electronic clinic records. Analysis was done at the patient and admission level, as some patients had multiple admissions. Of 5062 patients enrolled in care, 877 (17.3 %) had 1137 admissions at median age 24 months (IQR: 12–62). 191 (21.8 %) patients had multiple admissions. A high proportion of admissions occurred in patients under two years (49.4 %), those within one month of clinic enrollment (32.9 %), those with severe immune suppression (44.0 %), and those not on ART (48.5 %). The frequency of primary admission diagnoses varied across these same variables, with malnutrition, pneumonia, and malaria being the most common. Illness requiring hospitalization is common in HIV-infected and exposed children and these results reinforce the need for a comprehensive care package with special attention to nutrition. Strengthened programs for malaria prevention and expanded access to pneumococcal vaccine are also needed. The high burden of admissions in children under 24 months and those newly enrolled in care suggests a need for continued improvement of early infant diagnosis and provider-initiated testing programs to link patients to care before they are symptomatic. Similarly, the high proportion of admissions in those not yet started on ART emphasizes the importance of rapid initiation of ART for eligible pediatric patients.