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Achieving 90–90–90 in paediatric HIV: adolescence as the touchstone for transition success

机译:在儿科艾滋病毒中实现90–90–90:青春期是过渡成功的试金石

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IntroductionThe number of children less than 15 years estimated to be living with HIV globally approximated 3.2 million in 2013. Young people aged 15 to 24 years living with HIV approximated 4 million. The survival of these children and adolescents into adulthood poses new and urgent challenges of transition from the paediatric to adolescent to adult healthcare settings due to emerging developmental, psychosocial and comorbid issues. In order to achieve treatment targets of 90–90–90 across the continuum of care for paediatric HIV by 2020, focused efforts on the implementation of appropriate healthcare transition plans across the lifespan, with a focus on adolescence, should be prioritized.DiscussionPublished data or empirical evidence examining implementation of transition models and association with clinical outcomes are limited. While some guidelines do exist that offer recommendations about how to promote seamless transitions, very few data are available to assess the adequacy of these guidelines and whether they are effectively adhered to in clinical care settings globally. Furthermore, paediatric and adolescent HIV infection, either acquired perinatally or behaviourally, is set apart from other chronic illnesses as a highly stigmatizing disease that disproportionately affects poor, minority and often marginalized populations. Focused efforts on adolescence as the touchstone for transition practices and policies need to be implemented.ConclusionsOptimal healthcare for these vulnerable populations, particularly in resource-limited settings, will require HIV-specific transitional care services and programmes that are coordinated, collaborative, integrated and, importantly, evidence-based.
机译:简介2013年,据估计,全球少于15岁的儿童感染艾滋病毒的人数约为320万。15至24岁的年轻人感染艾滋病毒的人数约为400万。这些儿童和青少年成年后的生存面临着新的,迫切的挑战,即由于新兴的发展,心理和共病问题,从儿科到青少年过渡到成人医疗机构。为了在2020年实现小儿HIV连续治疗的90-90-90的治疗目标,应优先考虑在整个生命周期中实施适当的医疗保健过渡计划,重点是青春期。检验过渡模型的实施以及与临床结局的关系的经验证据有限。尽管确实存在一些指南,该指南提供了有关如何促进无缝过渡的建议,但很少有数据可用来评估这些指南的充分性以及它们是否在全球范围内均有效地遵循了临床护理环境。此外,无论是在围产期还是在行为上获得的小儿和青少年艾滋病毒感染,都与其他慢性病区分开来,这是一种高度污名化的疾病,严重影响着贫困,少数民族和边缘化人群。结论必须将青春期作为过渡做法和政策的试金石进行重点工作。结论对于这些弱势人群,尤其是在资源有限的人群中,要获得最佳医疗保健,需要针对艾滋病毒的过渡性照护服务和计划,这些服务和计划必须经过协调,协作,整合以及重要的是,基于证据。

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