瑞安·怀特艾滋病紧急救援计划资助诊所中艾滋病护理质量的性别差异。

Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics.

作者信息

Hirschhorn Lisa R, McInnes Keith, Landon Bruce E, Wilson Ira B, Ding Lin, Marsden Peter V, Malitz Faye, Cleary Paul D

机构信息

Harvard Medical School Division of AIDS, The Landmark Center, Harvard Medical School, Boston, Massachusetts 02215, USA.

出版信息

Womens Health Issues. 2006 May-Jun;16(3):104-12. doi: 10.1016/j.whi.2006.02.004.

DOI:10.1016/j.whi.2006.02.004

PMID:16765286

Abstract

BACKGROUND

Women with HIV infection have lagged behind men in receipt of critical health care, but it is not known if those disparities are due in part to where women receive care. We examined differences in care received by HIV-infected women and men in a national sample of Ryan White CARE Act-funded clinics and explored the influence of clinic characteristics on care quality.

METHODS

Record review was done on a sample of 9,015 patients who received care at 69 CARE Act-funded HIV primary care clinics that participated in a quality improvement study. Outcome measures studied were highly active antiretroviral therapy (HAART) use, HIV viral suppression, Pneumocystis jiroveci pneumonia (PCP) prophylaxis, screening, and other disease prevention efforts.

RESULTS

Women were less likely than men to receive HAART (78% versus 82%, p < .001), receive PCP prophylaxis (65% versus 75%, p < .0001), or have their hepatitis C virus status known (87% versus 88%, p = .02) despite being seen more regularly (69% versus 66%, p = .04). Sites serving high percentages of women delivered similar or better care for both men and women than other sites. Although sites serving a higher percent of women had more support services such as case management and onsite obstetrician-gynecologists and provided Pap smears at higher rates, women at such sites remained less likely than men to receive important HIV care including HAART and PCP prophylaxis.

CONCLUSIONS

The gap in the quality of care provided to HIV-infected men and women in critical areas persists, and is not explained by the types of sites where men and women receive care.

摘要

背景

感染艾滋病毒的女性在获得关键医疗保健方面落后于男性，但尚不清楚这些差异是否部分归因于女性接受治疗的地点。我们在全国范围内由瑞安·怀特关怀法案资助的诊所样本中，研究了感染艾滋病毒的女性和男性所接受治疗的差异，并探讨了诊所特征对医疗质量的影响。

方法

对9015名在69家参与质量改进研究的由关怀法案资助的艾滋病毒初级保健诊所接受治疗的患者样本进行记录审查。所研究的结果指标包括高效抗逆转录病毒疗法（HAART）的使用、艾滋病毒病毒抑制、耶氏肺孢子菌肺炎（PCP）预防、筛查及其他疾病预防措施。

结果

尽管女性就诊更为频繁（69%对66%，p = 0.04），但女性接受HAART治疗的可能性低于男性（78%对82%，p < 0.001），接受PCP预防的可能性低于男性（65%对75%，p < 0.0001），了解丙型肝炎病毒感染状况的可能性也低于男性（87%对88%，p = 0.02）。女性比例高的诊所为男性和女性提供的治疗与其他诊所相似或更好。尽管女性比例较高的诊所拥有更多支持服务，如病例管理和现场妇产科医生，且巴氏涂片检查率更高，但这些诊所的女性接受包括HAART和PCP预防在内的重要艾滋病毒治疗的可能性仍低于男性。