Legacy Community Health Services, Houston, TX, USA.
AIDS Behav. 2013 Jan;17(1):266-73. doi: 10.1007/s10461-011-0114-9.
Delayed diagnosis of HIV infection is a common problem. We hypothesized that persons with less trust in physicians and in the healthcare system would be diagnosed with lower CD4 cell counts than persons with more trust because they would delay seeking healthcare. From January 2006 to October 2007, 171 newly diagnosed HIV-infected persons, not yet in HIV primary care, were recruited from HIV testing sites in Houston, Texas, that primarily serve the under- and un-insured. The participants completed instruments measuring trust in physicians and trust in the healthcare system. Initial CD4 cell counts were obtained from medical record review. Mean trust scores for participants with CD4 cell counts ≥200 cells/mm(3) were compared with scores from participants with CD4 cell counts <200 cells/mm(3). We found that 51% of the cohort was diagnosed with a CD4 cell count <200 cells/mm(3). Neither trust in physicians nor trust in the healthcare system was an independent predictor of delayed diagnosis of HIV infection. In multivariate analysis, men who have sex with men and injection drug users were more likely to have early HIV diagnosis. Race/ethnicity was the only variable statistically significantly predictive of trust in physicians and in the healthcare system. Hispanics had the highest trust scores, followed by Blacks and Whites. Low trust is likely not a barrier to timely diagnosis of HIV infection.
HIV 感染的延迟诊断是一个常见问题。我们假设，与信任医生和医疗体系的人相比，对医生和医疗体系信任度较低的人，由于他们会延迟寻求医疗服务，因此 CD4 细胞计数会更低。2006 年 1 月至 2007 年 10 月，从休斯顿的 HIV 检测点招募了 171 名新诊断的 HIV 感染者，这些人尚未接受 HIV 初级保健，这些检测点主要为未参保和未投保的人群服务。参与者完成了衡量对医生和医疗体系信任的工具。从病历回顾中获得初始 CD4 细胞计数。将 CD4 细胞计数≥200 个/mm³的参与者的平均信任得分与 CD4 细胞计数<200 个/mm³的参与者的得分进行比较。我们发现，该队列中有 51%的人被诊断为 CD4 细胞计数<200 个/mm³。对医生的信任和对医疗体系的信任都不是 HIV 感染延迟诊断的独立预测因素。在多变量分析中，与男性发生性关系的男性和注射毒品者更有可能早期诊断出 HIV。种族/民族是唯一与对医生和医疗体系的信任具有统计学显著预测关系的变量。西班牙裔的信任得分最高，其次是黑人和白人。低信任可能不是 HIV 感染及时诊断的障碍。
