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The importance of caregivers in the outcome of pediatric HIV management, Mombasa, Kenya

机译：肯尼亚蒙巴萨的儿童艾滋病毒管理结果中看护者的重要性

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We assessed programmatic gaps that prevent the optimal treatment of pediatric HIV infection despite free antiretroviral care in Kenya. Of 626 HIV-infected Kenyan children, the median age was five years, 54% were male and the mortality rate was 3.2 per 100 person-years. A total of 380 (61%) children initiated antiretroviral therapy (ART) during the study period. Among the 246 children who never started ART, 129 (52%) met the criteria for ART initiation. Immunologic failure occurred in 20% of children who received ART for >24 weeks. In multivariate analysis, immunological failure was associated with having nonimmediate relative or unrelated caregivers accompanying the child to clinic (AOR = 69.16, p = 0.008). Having ≥3 types of accompanying caregivers was also associated with virologic failure in multivariate analysis (AOR = 3.84, p = 0.03). The lost to follow-up rate was 8.7/100 persons-years for the entire cohort, and significantly higher (17.7/100 persons-years) among children not on ART (p < 0.001). Among children who do initiate ART, those with the best treatment outcomes were those who had a limited number of close relatives as caregivers and good adherence to ART. Focus on early ART initiation and education of the right caregiver will likely improve retention and quality of pediatric HIV care in Kenya.
机译：我们评估了计划上的差距，尽管在肯尼亚有免费的抗逆转录病毒治疗，但这些差距仍然阻碍了小儿HIV感染的最佳治疗。在626名受HIV感染的肯尼亚儿童中，中位年龄为5岁，男性为54％，死亡率为每100人年3.2。在研究期间，共有380名儿童（61％）开始了抗逆转录病毒疗法（ART）。在246位从未开始抗逆转录病毒治疗的儿童中，有129位（52％）符合抗逆转录病毒治疗的标准。接受抗逆转录病毒治疗> 24周的儿童中有20％发生了免疫功能衰竭。在多变量分析中，免疫学失败与陪伴孩子到临床的非立即亲戚或无关亲戚有关（AOR = 69.16，p = 0.008）。在多变量分析中，具有≥3种伴随护理人员的类型也与病毒学失败有关（AOR = 3.84，p = 0.03）。整个队列的失访率是8.7 / 100人年，而未接受抗逆转录病毒治疗的儿童的失访率显着更高（17.7 / 100人年）（p <0.001）。在确实开始接受抗逆转录病毒治疗的儿童中，治疗效果最佳的儿童是那些照料者的近亲属数量有限且对抗逆转录病毒依从性良好的儿童。专注于早期抗逆转录病毒疗法的启动和正确护理者的教育可能会改善肯尼亚儿科艾滋病毒护理的保留率和质量。

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