背景:高效抗逆转录病毒疗法的引入显著改善了感染艾滋病毒的儿童和青少年的预期寿命,导致过渡到成人护理的人数增加。然而,在埃塞俄比亚,缺乏关于影响这一转变成功的因素的研究。因此,本研究旨在确定在埃塞俄比亚南部医疗机构感染HIV的青少年和年轻成人中,从儿科到成人HIV诊所成功过渡的预测因素.
方法:一项回顾性队列研究包括337名青少年和年轻人,他们过渡到面向成人的HIV护理。成功的过渡被定义为具有小于1000拷贝/ml的病毒载量并且在过渡后的第一年期间保持护理。对患者的抗逆转录病毒治疗(ART)卡和监测图进行了回顾。使用多变量二元逻辑回归模型进行二次数据分析,以确定成功过渡的预测因素。使用方差通货膨胀因子,我们检查了变量之间的多重共线性,并使用Hosmer和Lemeshow拟合优度检验评估了模型适合度.具有95%置信区间(CI)和P值≤0.05的校正赔率比(AOR)测量了关联强度和统计学意义。
结果:在337名参与者中,230(68.25%)成功过渡(95%CI=63.25,73.25)。18岁或以上时的过渡(AOR=4.25;95%CI=2.29,7.87),居住在城市地区(AOR=1.78;95%CI=1.04,3.02),并且接受抗逆转录病毒治疗超过2年(AOR=4.25;95%CI=1.17,4.94;P<0.017)被确定为阳性预测因子,机会性感染(AOR=0.34;95%CI=0.15,0.75;P<0.008)被确定为从儿童ART诊所成功过渡到成人ART诊所的阴性预测因子。
结论:这项研究揭示了HIV患者从儿童护理过渡到成人护理所面临的挑战,只有不到70%的人成功地浏览了这一关键阶段。转型年龄等因素,residence,艺术的持续时间,机会性感染的存在被确定为成功过渡的关键预测因素。这些发现强调了迫切需要有针对性的干预措施,包括解决年龄和城乡差距的标准化过渡计划,为该地区感染艾滋病毒的青少年和年轻人增加过渡成果。
BACKGROUND: The introduction of highly active antiretroviral therapy has significantly improved the life expectancies of children and adolescents living with HIV, leading to an increased number transitioning to adult care. However, there has been a lack of studies in Ethiopia focusing on factors influencing the success of this transition. Therefore, this study aimed to determine predictors of a successful transition from pediatric to adult HIV clinics among adolescents and young adults living with HIV in health facilities in southern Ethiopia.
METHODS: A retrospective cohort study included 337 adolescents and young adults who transitioned to adult-oriented HIV care. Successful transition was defined as having a viral load of less than 1000 copies/ml and maintaining care during the first year post-transition. Patients\' antiretroviral therapy (ART) cards and monitoring charts were reviewed. Secondary data analysis was conducted using a multivariable binary logistic regression model to identify predictors of a successful transition. Using the variance inflation factor, we checked for multi-collinearity between variables and assessed model fitness with the Hosmer and Lemeshow goodness-of-fit test. Adjusted Odds Ratio (AOR) with 95% confidence intervals (CI) and P-value ≤ 0.05 measured the strength of association and statistical significance.
RESULTS: Of 337 participants, 230 (68.25%) successfully transitioned (95% CI = 63.25, 73.25). Transitioning at age 18 or older (AOR = 4.25; 95% CI = 2.29, 7.87), residing in an urban area (AOR = 1.78; 95% CI = 1.04, 3.02), and being on antiretroviral therapy for more than two years (AOR = 4.25; 95% CI = 1.17, 4.94; P < 0.017) were identified as positive predictors and opportunistic infection (AOR = 0.34; 95% CI = 0.15, 0.75; P < 0.008) was identified as a negative predictor for a successful transition from pediatric to adult ART clinic.
CONCLUSIONS: This study sheds light on the challenges faced by HIV patients transitioning from pediatric to adult care, with less than 70% successfully navigating this critical phase. Factors such as age at transition, residence, duration of ART, and the presence of opportunistic infections were identified as key predictors of successful transition. The findings underscore the urgent need for tailored interventions, including standardized transition plans that address age and urban/rural disparities, to enhance transition outcomes for adolescents and young adults living with HIV in the region.