A Survey Of Cascade Diagnosis And Treatment Of HIV-infected Children Aged 5 Years And Under In My Country And Its Influencing Factors

Background:The introduction of antiviral therapy has effectively reduced the morbidity and mortality of infected people while prolonging the lifespan of HIV-infected people.HIV care cascade means that from HIV testing to participating in medical care to antiviral treatment,a series of processes of viral suppression will eventually be achieved.Loss at any step will increase the HIV-related morbidity,mortality and transmission risk of individuals and groups.At present,domestic and foreign researches on HIV care cascade are mostly concentrated on adults,and China lacks relevant data on HIV care cascade of HIV-infected children.EID testing helps promote the start of antiviral therapy and related care activities,reducing the incidence of early disease and death.Therefore,understanding the HIV care cascade of HIV-infected children in China and the related factors that affect the EID testing are of great significance for improving the treatment and care services for HIV-infected children in China.Objectives:(1)To understand the retaining status and the main influencing factors of HIV care cascade of HIV-infected children aged<5 years old in China;(2)Understand the relevant factors that affect the early diagnosis of children aged 5 years and younger in China,comprehensively understand the access to health services for children,and provide help for early diagnosis and treatment of local children.Method:(1)Analysis of HIV care cascade of HIV-infected children.Obtain the information of the target population through China’s HIV/AIDS Comprehensive Response Information Management System(CRIMS)and the National AIDS Treatment System,calculate the retention(or loss)rate that meets each step according to the definition,and use chi-square test and logistic regression model to analyze the factors that cause the loss in different stages;(2)On the result of cascade analysis,in Butuo County,Liangshan Prefecture,Sichuan Province,Yunnan Province,Xinjiang Uygur Autonomous Region,Guangxi Zhuang Autonomous Region and Guangdong Province,select HIV-infected children aged ≤5 years as of December 31,2018,and collect their families through face-to-face questionnaire survey and ask the information about the situation and the guardian’s awareness of early diagnosis.Result:(1)As of December 31,2018,there are 1,392 children aged<5 years with HIV diagnosis positive,of which 93.53%were retained in the medical care stage,of which 97.39%were retained in the follow-up maintenance step,and the retention rate of ART step was 82.79%,the retention rate in the continuous treatment step was 91.04%,the retention rate in the viral load testing step was 62.12%,and the retention rate in the virus suppression step was 78.33%.(2)The median time to start ART for children aged ≤ 5 years with HIV infection in China is 45.44 months.The OR of HIV-infected children with a baseline treatment region of 3TC+ABC+EFV/NVP entering the viral load testing step is 2.22 times that of taking 3TC＋AZT＋EFV/NVP as the baseline treatment region(95%CI:1.03-4.80),The OR of HIV-infected children with a baseline treatment region of 3TC+ABC+LPV/r entering the viral suppression step is 3.57 times that of the baseline treatment region of 3TC+AZT+EFV/NVP(95%CI:1.34-9.49).For children who receving ART off-site,the OR of them entering the virus suppression step is 2.50 times that of local treatment(95%CI:1.07～5.82).(3)In the questionnaire survey,a total of 130 HIV-infected children were investigated,of which 24(18.46%)children were diagnosed with HIV positive through EID testing.Chi-square analysis showed that the age(χ2=26.1754,p<0.0001),Ethnicity(χ2=23.8237,P<0.0001),type of place of residence(Χ2=9.7649,p=0.0018),testing institutions(Χ2=52.8116,p<0.0001),newborn EID testing awareness(Χ2=10.4019,p＝0.0013)and staff EID testing publicity(Χ2=4.8424,p-0.0278)are related to whether HIV-infected children receive early diagnosis.Conclusion and recommendation:The overall retention rate of HIV care cascade in children ≤5 years of age in China is relatively high,which still has a certain gap between the coverage of antiviral treatment and the rate of viral suppression compared to the three 90%targets.The coverage rate of EID testing is low,and the guardians of HIV-infected children lack the knowledge and knowledge about their children’s infection.It is recommended to expand the coverage of viral load testing,optimize the structure of care and treatment services for children,improve the quality of services,and improve the quality of antiviral treatment services for children in remote and low-economic areas.Improve the guardian’s knowledge and behavior consistency of EID testing.