New York City Department of Health and Mental Hygiene, HIV Epidemiology and Field Services Program, New York, NY.
J Acquir Immune Defic Syndr. 2014 Apr 15;65(5):571-8. doi: 10.1097/QAI.0000000000000077.
Comprehensive laboratory reporting of CD4 and viral load (VL) tests to surveillance has been used to assess HIV care-related outcomes at the population level, but their validity for this purpose has not been comprehensively evaluated.
Assess performance characteristics and validity of surveillance-based measures of linkage to and establishment of HIV primary care among HIV-infected persons in the first 12 months after diagnosis using medical record (MR) data on outpatient HIV primary care visits as the gold standard.
All patients diagnosed with HIV in 2009 at 24 New York City high-volume, HIV diagnostic and treatment facilities who linked to care within 12 months at the same site as defined by the presence of ≥1 CD4/VL report received by surveillance were selected for MR review to confirm linkage to outpatient HIV primary care within the first year. All HIV care visit dates were abstracted and considered associated with a surveillance laboratory report, if within 14 days of a care visit. The proportion linking to care according to the MR was compared with the proportion linking per CD4/VL tests reported to surveillance. Four measures of the establishment of outpatient HIV primary care in the first year were assessed: (1) sustained care (first visit within 3 months; second visit, 3-9 months later), (2) continuous care (2 visits at least 90 days apart), (3) trimester visits (visit in each 4-month period), and (4) visit constancy (visit in each 3-month period). The validity of surveillance data for measuring this outcome was assessed by comparing results for each of the 4 measures calculated using surveillance data to those calculated using MR data.
Of the 782 patients selected, 20% (N = 157) of patients did not link to outpatient HIV primary care at the co-located care facility within 12 months of diagnosis. Half (48.5%) of patients' care visits after linkage did not have an associated CD4/VL reported to surveillance. Of the 4 establishment measures, sustained and continuous care had the highest agreement with MR (86.6% and 88.8%, respectively) as compared with the trimester visits and visit constancy (77.8% and 72.8%, respectively).
Surveillance data overestimated linkage rates but underestimated the frequency of HIV care in the first year after HIV diagnosis. Of the 4 measures of establishment of HIV care evaluated, "sustained care" is best suited for measurement using surveillance data because of its high level of agreement with MR data and close alignment with national standards for timely linkage and flexible follow-up.
综合实验室报告 CD4 和病毒载量（VL）检测结果用于监测，可以评估人群中与艾滋病毒护理相关的结果，但尚未全面评估其用于该目的的有效性。
使用门诊艾滋病毒初级保健医疗记录 (MR) 数据作为金标准，评估基于监测的与艾滋病毒感染者在诊断后 12 个月内联系和建立艾滋病毒初级保健的指标的表现特征和有效性。
从 2009 年在纽约市 24 个高容量 HIV 诊断和治疗机构诊断出的所有 HIV 感染者中，选择在 12 个月内与其作为诊断和治疗场所的同一个机构联系的患者，通过存在至少 1 份 CD4/VL 报告来确定，该报告是通过监测收到的。对所有 HIV 护理就诊日期进行了摘录，并认为如果就诊日期在护理就诊日期的 14 天内，则与监测实验室报告相关联。将根据 MR 确定的联系护理的比例与报告给监测的 CD4/VL 测试的联系比例进行比较。评估了在第一年建立门诊 HIV 初级保健的四项措施：（1）持续护理（第一个就诊时间在 3 个月内；第二个就诊时间在 3-9 个月后）；（2）连续护理（至少两次就诊时间间隔 90 天）；（3）孕期就诊（每个 4 个月就诊一次）；（4）就诊规律（每个 3 个月就诊一次）。通过比较使用监测数据和使用 MR 数据计算出的每一项措施，评估了监测数据测量该结果的有效性。
在所选择的 782 名患者中，20%（N=157）的患者在诊断后 12 个月内未在合作的护理机构中联系门诊艾滋病毒初级保健。一半（48.5%）的患者联系后的护理就诊没有与监测相关的 CD4/VL 报告。在 4 项建立措施中，持续护理和连续护理与 MR 的一致性最高（分别为 86.6%和 88.8%），而孕期就诊和就诊规律的一致性较低（分别为 77.8%和 72.8%）。
监测数据高估了联系率，但低估了 HIV 诊断后第一年的艾滋病毒护理频率。在所评估的 4 项 HIV 护理建立措施中，“持续护理”最适合使用监测数据进行测量，因为它与 MR 数据具有很高的一致性，并且与及时联系和灵活随访的国家标准密切一致。
