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Lost to follow-up: failure to engage children in care in the first three months of diagnosis

机译：失去随访：在诊断的前三个月没有让儿童参与护理

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Loss to follow-up (LTFU) is a critical factor in determining clinical outcomes in HIV treatment programs. Identifying modifiable factors of LTFU is fundamental for designing effective patient-retention interventions. We analyzed factors contributing to children LTFU from a treatment program to identify those that can be modified. A case-control study involving 313 children was used to compare the sociodemographic and clinical characteristics of children LTFU (cases) with those remaining in care (controls) at a large pediatric HIV care setting in Botswana. We traced children through caregiver contacts and those we found, we conducted structured interviews with patients' caregivers. Children <5 years were nearly twice as likely as older children to be LTFU (578% versus 309%, p<0.01). Approximately half (476%, n=51) of LTFU patients failed to further engage in care after just one clinic visit, as compared to less than 1% (n=2) in the control group (p<0.01). Children LTFU were more likely than controls to have advanced disease, greater immunosuppression, and not to be receiving antiretroviral therapy. Among interviewed patient caregivers, psychosocial factors (e.g., stigma, religious beliefs, child rebellion, disclosure of HIV status) were characteristics of patients LTFU, but not of controls. Socioeconomic factors (e.g., lack of transportation, school-related activities, forgetting appointments) were cited predominantly by the controls. Pediatric patients and their caregivers need to be targeted and engaged at their initial clinic visit, with special attention to children <5 years. Possible interventions include providing psychosocial support for issues that deter patients from engaging with The Clinic. Collaboration with community-based organizations focused on reducing stigma may be useful in addressing these complex issues.
机译：随访失败（LTFU）是决定HIV治疗计划临床结果的关键因素。识别LTFU的可改变因素是设计有效的患者保留干预措施的基础。我们分析了从治疗计划中导致儿童LTFU的因素，以找出可以修改的因素。一项涉及313名儿童的病例对照研究被用来比较博茨瓦纳大型儿童HIV护理机构中儿童LTFU（病例）与仍在护理中的儿童（对照）的社会人口统计学和临床​​特征。我们通过看护者的联系追踪了孩子，发现了他们，我们对患者的看护者进行了结构化访谈。 <5岁的儿童患LTFU的可能性几乎是年龄较大的儿童的两倍（578％比309％，p <0.01）。仅一次诊所就诊后，大约一半（476％，n = 51）的LTFU患者无法进一步从事护理，而对照组中只有不到1％（n = 2）（p <0.01）。儿童LTFU比对照组更有可能患有晚期疾病，更大的免疫抑制以及不接受抗逆转录病毒治疗。在接受采访的患者护理人员中，心理社会因素（例如，污名，宗教信仰，儿童叛乱，HIV状况的披露）是患者LTFU的特征，但不是对照者的特征。控件主要引用了社会经济因素（例如，交通不便，与学校相关的活动，忘记约会）。小儿患者及其护理人员应在初诊时有针对性地投入治疗，尤其要注意5岁以下的儿童。可能的干预措施包括为阻碍患者参与诊所的问题提供社会心理支持。与专注于减少污名化的社区组织合作可能有助于解决这些复杂的问题。

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